Pregnancy in lupus nephritis and related disorders.

We studied retrospectively the influence of lupus nephropathy on the outcome of pregnancy and of pregnancy on the course of lupus nephritis in 213 pregnancies observed from 1962 to 1985 in a series of 73 patients with systemic lupus erythematosus (SLE). Renal biopsy demonstrated diffuse or focal proliferative glomerular lesions in 48 of 66 patients. The overall incidence of live births was 162 in 213 (76%). Fetal death rate, corrected for induced abortions, was markedly higher when SLE first manifested during or immediately after the index gestation (five of 11, or 45%) than in pregnancies that began prior to clinical onset of SLE (16 of 140, or 11.4%) and in those occurring after onset of SLE (five of 38, or 13.1%). Relapse or an exacerbation of SLE activity occurred in 18 (34%) of 53 pregnancies (in 35 women) which took place after the clinical onset of the disease. Such complications were more frequent (16 of 26 cases, or 61%) in pregnancies in which SLE was clinically active at conception as compared with gestations in which SLE was in clinical remission prior to conception (two of 27 cases, or 7%). There were six instances of severe renal "flare-up," four of which progressed to end-stage renal failure (ESRF) within a few years, including one instance in a patient who was in remission before conception. We conclude that successful outcome of pregnancy without deterioration of maternal renal function may most often be obtained even in previously severe forms of SLE, provided gestation is started in a period of sustained therapeutic remission.(ABSTRACT TRUNCATED AT 250 WORDS)