Background Systemic lupus erythematosus (SLE) is a chronic auto-immune disease, which mainly occurs in women during childbearing age. It is associated with several fetal and maternal complications.

Objective To describe obstetrical complications and evaluate pregnancy and fecundity rates in women with SLE.

Methods It is a retrospective study including 227 women with SLE. Only 143 women, who are sexually active, were studied.

Results The mean age at disease onset was 36.61±13.41 years. The mean age at SLE diagnosis was 38.47±13.43 years. The most frequent manifestations of the disease were lupus nephritis and neurological involvements, seen in respectively 39.7% and 14.7% of patients. Antinuclear antibodies were positive in 96.5% of cases and anti-dsDNA were positive in 96.3% of cases. Anti-SSA, anti-SSB, anti-cardiolipin and anti-B2GPI antibodies were found in respectively 68, 37.3, 46% and 27.3% of patients. Corticosteroids were given in 90.4% of patients and 58% of them had immunosuppressive therapy: Cyclophosphamide (n=42), Azathioprine (n=30), Methotrexate (n=9) and Mofetil Mycophenolate (n=2).

Obstetrical complications were: spontaneous abortion before the 10TH week of gestation (22.8%), unexplained fetus death after the 10TH week of gestation (12.2%) and intrauterine death (10%).

Among the 143 women, 130 had at least one pregnancy (average=3.59±2.62 pregnancies). Most pregnancies resulted in live births; 121 women had at least one child with an average of 2.55±2 children/woman. Pregnancies occurred after SLE diagnosis in 40 women (among 69 who wants to have children) with a mean of 1.75±1.05 pregnancies. Twenty nine women had at least one child with a mean of 1.15±0.9 children. In addition to their usual treatment, other drugs were added during pregnancies: aspirine (n=7), low molecular weight heparin (n=7) and betamethasone in one case. One patient was treated with aspirine and low molecular weight heparin. Obstetrical events caused lupus flare in 11 cases (pregnancy in 7 cases, delivery in 2 cases, intrauterine death and spontaneous abortion each in one case).

Conclusion Comparing to general population in Tunisia (2 children/woman), fecundity is reduced in women after SLE diagnosis. Complications are related to disease activity, antiphophspholipid antibodies and hypertension.