Neurological involvement and pregnancy outcomes in autoimmune disease: mechanisms, clinical implications, and research gaps.

Pregnancy in systemic autoimmune diseases is associated with increased maternal and fetal morbidity, yet the specific impact of neurological involvement remains poorly characterized. This review synthesizes pregnancy outcomes in systemic lupus erythematosus (SLE), Sjögren's syndrome, sarcoidosis, and Behçet's disease, focusing on neurological manifestations. A narrative review (2010-2025) was conducted via PubMed/MEDLINE. Observational cohorts, registries, and systematic reviews reporting maternal, fetal, and neonatal outcomes were included. Across autoimmune conditions, pregnancy risks are significantly elevated, most pronounced in SLE. Meta-analyses in SLE reported preeclampsia rates of 2-35%, preterm birth in 14.7-50%, and fetal loss up to 21.7%. In sarcoidosis, studies showed increased risks of preeclampsia (OR 1.62) and preterm delivery (OR 1.73), while Sjögren's syndrome was associated with congenital heart block in up to 17.9% of at-risk pregnancies. Neurological manifestations are frequently documented but rarely analyzed as independent risk factors; in one study, neuropsychiatric lupus was associated with higher rates of maternal (38.1% vs 14.1%) and fetal complications, although evidence remains limited and should be interpreted with caution. Neurological involvement is a critical but under-studied dimension of pregnancy risk. Improved phenotyping, multidisciplinary care, and prospective registries are needed to optimize risk stratification and maternal-fetal management.