Objective Adverse events during pregnancy are common in systemic lupus erythematosus (SLE). For this reason, EULAR recommends its management in specialized pregnancy clinics. Our aim is to report the 10-year experience of a pregnancy clinic in a tertiary center in Spain.

Methods Retrospective study of patients with SLE followed up in a specialized pregnancy clinic at a tertiary center in Madrid, Spain, who attended the clinic from December 2012 to January 2023. Categorical variables were described as proportions and/or percentages, while continuous variables were shown as mean and standard deviation (SD) or median and interquartile range (IQR) when appropriate.

Results 56 cases of pregnancy counselling’s in 38 patients with SLE were included. The main characteristics are reported in table 1. Preconception consultation was performed in 57.1% (32/56) of the cases since 42.9% (24/56) were already pregnant in the 1st visit; 58.3% (14/24) of pregnant patients were referred from services other than Rheumatology. Before 1^st visit, only 48.2% (27/56) of SLE patients had been treated with hydroxychloroquine (HCQ) and 33.3% (5/15) of patients treated with corticosteroids had doses ≥ 10 mg/day. At the first visit, treatment adjustment was recommended to 46.9% (15/32) of patients being the introduction of HCQ was the most frequent. The pregnancy rate was 80.4% (45/56) and 6 (13.3%) ended in spontaneous abortion. 80% (36/45) pregnancies ended with a live birth, 6/36 (16.7%) flared. During pregnancy the use of corticosteroids continued to be around 33.3% (n=12/36), median dose 6.9 mg/day (IQR 3.1–10.0). The most frequent delivery was eutocic 27/36 (75%) at a median of 39.2 GW (IQR 37.6–40.1). An adverse pregnancy outcome occurred in 44.4% (n=16/36) of the pregnancies, being gestational diabetes and premature rupture of membranes the most frequent ones. Preeclampsia was found in 5.6% (n=2/36) of the pregnancies and 12.1% (n=4/36) of the neonates had low birth weight.

Conclusions Besides high rates of pregnancy at 1^st visit there was a low rate of flares and adverse outcomes. Pregnancy planning should be carried out to minimize the risk of adverse events during pregnancy. It is advisable to closely monitor pregnancies in patients with SLE in specialized clinics.