Lupus during pregnancy

By trimester

Weeks 1–13

1st trimester

Before conception or at the first visit, review disease activity, kidney function, blood pressure, antibody results, and every medicine with rheumatology and maternal-fetal medicine. Do not abruptly stop disease-control medication because a pregnancy test is positive.

Weeks 14–27

2nd trimester

The team follows symptoms, blood pressure, urine and blood findings, fetal growth, and any antibody-specific concerns. New swelling or abnormal urine results may need evaluation for both lupus activity and pregnancy complications.

Weeks 28–birth

3rd trimester

Prepare a birth and postpartum plan covering disease monitoring, clotting risk, medication compatibility, and infant feeding. Flares can occur after delivery, so follow-up should continue even when pregnancy was quiet.

What does the evidence show for lupus?

• SMFM recommends coordinated care, individualized pregnancy planning, growth surveillance, and antenatal testing for systemic lupus erythematosus. Active kidney disease or severe organ involvement can substantially change pregnancy risk and preconception advice. 1
• The American College of Rheumatology guideline emphasizes pregnancy planning during disease quiescence and use of compatible medicines. Many recommendations rely on limited evidence, making shared decisions with rheumatology and obstetric teams essential. 2
• The prospective PROMISSE cohort studied 385 pregnancies with inactive or stable mild to moderate lupus. Most did not have the study’s composite adverse outcome, but active severe disease was excluded; its reassuring results cannot be applied to all lupus pregnancies. 3
• A prospective Greek study of 82 pregnancies associated low disease activity at conception with fewer fetal complications and antiphospholipid antibodies with more complications. Flares occurred during pregnancy and postpartum. Observational associations do not establish an individual forecast. 4
• SMFM supports hydroxychloroquine continuation or initiation in most lupus pregnancies, with shared decisions for selected quiescent patients off medication. Aspirin and anticoagulation decisions depend on specific risks; positive antibodies do not automatically mean every patient needs the same regimen. 1

When should I call my provider about lupus?

Seek emergency care for chest pain, breathing difficulty, fainting, seizure, sudden weakness, severe headache with visual changes, or severe abdominal pain. Contact the maternity team urgently for new marked swelling, reduced urine, concerning blood pressure, fever, or reduced fetal movement. Do not assume a new symptom is simply a familiar lupus flare. None of these lists replace your own judgment: if this symptom worries you, that on its own is enough reason to check in with your healthcare provider.