It is recommended that pregnancies in women with systemic lupus erythematosus (SLE) occur during periods of disease stability, typically six months prior to conception. Active SLE at conception increases the likelihood of adverse outcomes, although most pregnancies in these cases still result in live births. Preconception evaluation is crucial to assess maternal and fetal risks, optimize disease management, and adjust medications for safety. Collaboration between a rheumatologist and experienced obstetrician is essential for managing pregnant women with SLE, including monitoring disease activity throughout pregnancy and postpartum. Continuation of hydroxychloroquine is often advised to reduce the risk of SLE flares. Preeclampsia risk is higher in SLE pregnancies, and prophylactic low-dose aspirin may be recommended. Lupus nephritis flares during pregnancy can mimic preeclampsia, necessitating careful differentiation. Women with specific risk factors may require closer monitoring, including increased surveillance for congenital heart block in cases of positive anti-Ro/SSA and/or anti-La/SSB antibodies. Treatment of active SLE during pregnancy should be based on the severity of organ involvement, weighing risks and benefits against potential harm to the mother and fetus.
