Pregnancy and fetal outcome in lupus nephritis

SLE is a multisystem autoimmune disease involving both humoral and cellular aspects of the innate and acquired immune systems. Lupus is characterized by autoantibodies that participate in disease pathogenesis. Lupus occurs worldwide and affects females more commonly than males (10:1), and some racial groups, such as blacks and Hispanics.It was not that long ago that systemic lupus erythematosus (SLE) was considered a contraindication to pregnancy. With improved understanding and improved treatment options, many women with SLE have successful pregnancies. Still; lupus flare during pregnancy is a medical and obstetric emergency, and a persistent obstetric dilemma.The effects of pregnancy on lupus are controversial, and the reports of lupus flares during pregnancy are conflicting. There are studies that show an increase in lupus flares during pregnancy, and others that show no increase in flares.Exacerbations of maternal disease are said to occur in 30-50% of pregnancies. This frequency is two to three times greater if lupus is active at the time of conception with a higher proportion of the exacerbations occurring during the second and third trimesters and the post partum period. Pregnancy does not alter the long-term course of the disease and consequently pregnancy is not contraindicated.Pregnancy in women with lupus nephritis is associated with an increased risk of fetal loss and with worsening of the renal and extrarenal manifestations. After delivery exacerbations of lupus nephritis occurs