Background SLE primarily affects young women in their childbearing years and lupus nephritis is a common complication that often develops early in the disease course. Patients with lupus nephritis are at increased risk of fetal and maternal morbidity.

Methods Careful pre-pregnancy counselling is essential and should involve a multidisciplinary team with experience of managing high risk pregnancies. Careful management of active lupus nephritis aiming for complete clinical remission and optimising treatment to safely discontinue fetotoxic therapies is essential prior to discussing pregnancy. While these aspects are being managed, effective contraception is vital to avoid unplanned pregnancy with active lupus nephritis. The broader picture including previous obstetric history, assessment for antiphospholipid antibodies and neonatal lupus syndrome in Ro/La positive women also needs to be considered. Patients with lupus nephritis, even when in remission need very close monitoring throughout pregnancy and the post-natal period.

Results Data in the literature suggests that lupus flares including lupus nephritis flares, hypertension and pre-eclampsia may occur in up to 25% of patients. Lupus nephritis flares in pregnancy increase the risk of renal impairment, intra-uterine growth restriction, premature delivery and fetal morbidity including stillbirths and neonatal deaths and rarely maternal mortality.

Conclusions With careful management, women with lupus nephritis can have successful pregnancies.