The aim of this multicenter study was to assess the present risk of fetal complications and the inherent risk factors in pregnant women with
lupus nephritis. Seventy-one pregnancies in 61women (59 Caucasians and 2 Asians) with
lupus nephritis were prospectively followed between October 2006 and December 2013. All patients received a counselling visit within 3 months before the beginning of pregnancy and were followed by a multidisciplinary team. At baseline mild active
nephritis was present in 15 cases (21.1%). Six pregnancies (8.4%) resulted in fetal loss. Arterial
hypertension at baseline (P = 0.003), positivity for
lupus anticoagulant (P = 0.001), anticardiolipin
IgG antibodies (P = 0.007), antibeta2
IgG (P = 0.018) and the triple positivity for
antiphospholipid antibodies (P = 0.004) predicted fetal loss. Twenty pregnancies (28.2%) ended pre-term and 12 newborns (16.4%) were small for gestational age. Among the characteristics at baseline, high SLE disease activity index (SLEDAI) score (P = 0.027),
proteinuria (P = 0.045), history of renal flares (P = 0.004), arterial
hypertension (P = 0.009) and active
lupus nephritis (P = 0.000) increased the probability of preterm delivery. Odds for preterm delivery increased by 60% for each quarterly unit increase in SLEDAI and by 15% for each quarterly increase in
proteinuria by 1 g per day. The probability of having a small for gestational age baby was reduced by 85% in women who received
hydroxychloroquine therapy (P = 0.023). In this study, the rate of fetal loss was low and mainly associated with the presence of
antiphospholipid antibodies. Preterm delivery remains a frequent complication of pregnancies in lupus. SLE and
lupus nephritis activity are the main risk factors for
premature birth. Arterial
hypertension predicted both fetal loss and preterm delivery. Based on our results the key for a successful pregnancy in
lupus nephritis is a multidisciplinary approach with close medical, obstetric and neonatal monitoring. This entails: a) a preconception evaluation to establish and inform women about pregnancy risks; b) planning pregnancy during inactive
lupus nephritis, maintained inactive with the lowest possible dosage of allowed drugs; c) adequate treatment of known risk factors (arterial
hypertension, antiphospholipid and
antibodies); d) close monitoring during and after pregnancy to rapidly identify and treat SLE flares and obstetric complications.