Objective SLE can present with disease flares during pregnancy and postpartum period resulting in adverse pregnancy outcomes (APO). Herein we aimed to determine the effects of pregnancy on disease activity and the correlation of disease flares and APO.

Methods A total of 168 pregnancies involving 136 patients were included. Clinical and laboratory findings were described and disease activity was calculated using SLEDAI-2K (in the preconceptional period, all trimesters and postpartum). Flares and patients with low lupus disease activity scores(LLDAS) during each of these periods were identified. Fetal/neonatal death, premature birth due to preeclampsia, eclampsia or HELLP syndrome, neonates small for gestational age were described as APO and its relation to disease activity was studied

Results Mean SLEDAI-2K scores was 1.3±2.2 (0–16) in the preconceptional period, 1.7±3.2 (0–22) in the first trimester, 1.4±2.7 (0–16)in the second, 1.5±3.3 (0–20) in the third and 3.5±5.4 (0–26) in the post-partum period. Mean postpartum SLEDAI-2K score was higher compared to the mean pregnancy SLEDAI-2K score (p<0.05). 79% of all pregnancies sustained LLDAS and%19 percentage of pregnancies resulted in flares of which 42% were serious and 58 mild-moderate in severity. 49% of severe flares occurred during postpartum period, significantly higher compared to all trimesters (p<0.05). Most of the flares had mucocutaneous(%37), renal(35%) and haematologic (25%) involvement.

APO emerged in 34% of pregnancies. APO (+) group had significantly longer disease duration compared to APO (-) group (142±70 vs 170±88 mn, p<0.05) and higher disease activity during all periods.% of patients with severe disease activity was significantly low in APO (-) GROUP (%18 vs 35, p<0.05) and% with LLDAS was much higher (%88 vs 70).

Conclusion Postpartum period has the highest risk for disease during SLE pregnancies. Active disease during pregnancy increases the risk of APO. Patients with sustained LLDAS have significantly lower APO rates. For a positive pregnancy outcome control of disease activity both during pregnancy and postpartum is required.