Systemic Lupus Erythematosus (SLE) is a 
systemic autoimmune disease predominantly affecting 
women of childbearing age. Pregnancy in women with SLE 
is associated with higher fetal and maternal risk compared 
with the general population. SLE flares, higher rates of 
pregnancy complications and the risk of Neonatal Lupus 
Syndromes (NLS), especially congenital Complete Heart 
Block (CHB) are major concerns. Pregnancy complications 
include fetal loss, preeclampsia, preterm delivery and Intra
Uterine Growth Restriction (IUGR). High disease activity, 
renal involvement and the presence of antiphospholipid 
(aPL) antibodies, anti-SSA/Ro and SSB/La specific 
antibodies are particularly at risk. As normal physiological 
changes during pregnancy could show symptoms and signs 
resembling those with active SLE, it is sometimes difficult 
to distinguish between these conditions. One of the 
candidate clinical markers would be high titer of anti
double-stranded DNA antibodies to distinguish between 
flare of SLE and normal physiological changes during 
pregnancy. Medications during pregnancy are also an 
important issue. Some immune-suppressants such as 
cyclophosphamide or Mycophenolate Mofetil (MMF) should 
not be taken during pregnancy. Non-fluorinated steroids, 
calcineurin inhibitors and azathioprine can be used and 
continuous use of hydroxy chloroquine during pregnancy is 
considered beneficial. Administration of low-dose aspirin 
prior to 16 weeks of gestation should be considered in all   pregnant women with SLE at elevated risk of preeclampsia. In conclusion, it is important that disease progression and 
development of auto antibodies be monitored in pregnant 
women at risk of SLE in order to ensure good outcomes. 

Keywords: Fetal Loss; Intra-Uterine Growth Restriction 
(IUGR); Neonatal Lupus; Pregnancy; Preeclampsia; 
Systemic Lupus Erythematosus