Objective Despite the many years efforts of physicians and scientist to improve the outcome of pregnancies in patients with systemic lupus erythematosus (SLE), a recent publication¹ underlines the occurrence of many complications for the mother and the child. Aim pf this abstract is to summarize the better strategies to ensure a good maternal and neonatal outcome.

Methods The physicians’ task should be considered in 3 different scenarios: before, during and after pregnancy. The correct approach and the challenges of these 3 periods will be analyzed.

Results Ideally, a patient should start the pregnancy when the diseases is in low disease activity or in stable remission under a treatment safe for the fetal health. This is not always the case because sometimes unwanted pregnancies occur or, in other circumstances, desired pregnancies do not come. In both cases the treating physician will be involved in the solution finding process so it could be of help to know in advance what could be done and prepare sound specific protocols. The pre-conceptional counselling also involves the case specific evaluation of potential risk factors for the future pregnancy. These include the evaluation of lupus phenotype, antibody profile and other biomarkers such as the complement system whose levels are important predictors of fetal outcome even if not linked to clinically important disease activity.²

The monitoring of lupus patients during gestation is performed by a multidisciplinary team where gynecologist together with rheumatologists/internists are the main players. It is sometimes difficult to have different specialists at the same time in the same place, so different organizational models of multidisciplinary team have been developed to ensure quick consultation and decision sharing. An early diagnosis of lupus flares and pregnancy complications allow in many cases effective treatments.

Puerperium is a difficult time for all the women. But for mothers with systemic lupus it is also combined with doubts on lactation and pharmacological treatment, disease linked fatigue that has to be added to the overworking of the period, and risk of disease flares often occurring. At this time, the patients need to be closely followed by the treating specialists to prevent disease relapses and also to avoid the occurrence of depression, potentially dangerous also for the child growth.

Conclusions SLE is a relatively rare disease, and this do not facilitate physicians to face peculiar aspects of their patients’ life such as reproduction. On the other had the high prevalence of young women in the affected population support the need of detailed protocols to follow them before, during, and after pregnancy. A pre-conceptional counselling with consequent appropriate disease management, a multidisciplinary pregnancy monitoring, and a careful care of puerperium can significantly reduce the problems often reported when data are driven from admirative registries¹ and not prospectively followed cohorts.²

Acknowledgements The author wants to acknowledge the multidisciplinary team of colleagues working in the Rheumatology Pregnancy Clinic that has allowed a happy family life for many SLE patients.

References

1. Mehta B, Jannat-Khah D, Glaser KK, et al. Fetal and maternal morbidity in pregnant patients with Lupus: a 10-year US nationwide analysis. RMD Open 2023;9:e002752.

2. Crisafulli F, Andreoli L, Zucchi D, et al. Variations of C3 and C4 before and during pregnancy in systemic lupus erythematosus: association with disease flares and obstetric outcomes. J Rheumatol. 2023 Oct;50(10):1296–1301.