Pregnancy and Fertility in Systemic Lupus Erythematosus

Attention to reproductive issues is an important aspect of caring for systemic lupus erythematosus (SLE) patients. While primary infertility is not increased among these patients, secondary infertility may be increased, most commonly related to active disease, renal insufficiency, prior medication exposure, and advanced maternal age. Assisted reproductive technologies can be used in SLE with the same restrictions that apply to pregnancy. During pregnancy, disease is more likely to flare, in particular in those with renal disease and active disease in the 6. months preceding pregnancy. Preeclampsia and maternal morbidity are more common in SLE patients, and poor pregnancy outcomes are increased, with higher rates of miscarriage, preterm premature rupture of the membranes, small for gestational age infants, and fetal death. While not all medications can be used during pregnancy, hydroxychloroquine, glucocorticoids, and the immunosuppressives azathioprine, cyclosporine, and tacrolimus can be prescribed. Carefully timing pregnancy at a time of disease quiescence on safe medications and using a multidisciplinary care team including rheumatology and maternal fetal medicine can lead to good pregnancy outcomes in most SLE patients.