Fertility and pregnancy in systemic lupus erythematosus

Reproductive issues are an important aspect of systemic lupus erythematosus (SLE) patient care. While SLE itself does not increase the risk of infertility, prior exposure to cyclophosphamide, active disease, renal insufficiency, and advanced maternal age can contribute to difficulties conceiving. SLE patients can undergo assisted reproductive technologies as long as disease is under good control. During pregnancy, disease is more likely to flare in those with a history of renal disease and/or active disease in the 6 months preceding pregnancy. Preeclampsia and maternal morbidity are more common in SLE patients, and poor pregnancy outcomes such as preterm premature rupture of the membranes, small for gestational age infants, and fetal death are increased. Pregnancy loss is more frequent in those patients who have co-existing antiphospholipid syndrome. While not all medications can be used during pregnancy, hydroxychloroquine, glucocorticoids, and the immunosuppressives azathioprine, cyclosporine, and tacrolimus are compatible with pregnancy. We recommend that women with SLE take hydroxychloroquine and baby aspirin during pregnancy. Planning pregnancy during a time of disease quiescence on medications compatible with pregnancy and a multidisciplinary care team approach that includes rheumatology and maternal fetal medicine can lead to good pregnancy outcomes in most SLE patients.