Systemic lupus erythematosus in pregnancy: Maternal and fetal outcomes and management strategies (Review).

Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease that predominantly affects women during their reproductive years. Pregnancy in women with SLE is no longer considered uniformly prohibitive; however, it remains a high-risk clinical scenario due to maternal disease activity, lupus nephritis, antiphospholipid antibodies, chronic organ damage, and treatment-related factors that can adversely affect both maternal and fetal outcomes. Current evidence indicates that the risk of flare is highest in women who conceive with an active disease, discontinue effective therapy, or have a history of major organ involvement. At the same time, pregnancy introduces diagnostic complexity due to physiological gestational changes which may mimic lupus activity, particularly in hematological, renal and vascular domains. Maternal complications include preeclampsia, thromboembolism, infection, lupus nephritis exacerbation and postpartum flare, whereas fetal complications include miscarriage, fetal growth restriction, prematurity, neonatal lupus and congenital heart block in anti-Ro/SSA- or anti-La/SSB-positive pregnancies. Optimal management begins prior to conception and requires multidisciplinary care, risk stratification, medication optimization and structured maternal-fetal surveillance throughout pregnancy and the puerperium. The present narrative review summarizes contemporary evidence on the immunopathogenesis, preconception assessment, maternal and fetal risks, and therapeutic management of SLE in pregnancy, with an emphasis on clinically applicable strategies that improve patient outcomzes.