Systemic lupus erythematosus and pregnancy outcomes: an update and review of the literature

Abstract

Purpose of review: This review synthesizes new data from the studies published between 2011 and 2013, with particular focus on the different information gleaned by various study types.

Recent findings: Population-based cohorts have demonstrated that women with systemic lupus erythematosus (SLE) have fewer live births and more pregnancy complications, but can have successful live births after having a poor outcome. A retrospective study suggests that only 4 months, not the traditional 6 months of disease quiescent SLE prior to pregnancy improves outcomes. Prospective studies identified several novel predictors of poor pregnancy outcomes, including uterine Doppler and laboratory findings. A prospective study found great success in transitioning to azathioprine from mycophenolate mofetil prior to pregnancy in patients with quiet lupus nephritis. Two retrospective analyses suggest that hydroxychloroquine may prevent congenital heart block in pregnancies exposed to SSA/Ro antibodies. Finally, the initial pregnancy data for belimumab suggest a high degree of transplacental transfer, but thus far no definitive link between belimumab and congenital abnormalities.

Summary: Recent studies suggest both novel markers of poor pregnancy outcomes and new approaches to the management of lupus during pregnancy.