The risk for preeclampsia and other adverse outcomes in pregnant women with systemic lupus erythematosus (SLE) rises even higher with lupus nephritis (LN), a new study finds.

Of 103 women with SLE who gave birth at the Karolinska University Hospital in Stockholm, Sweden, from 2000 to 2017, 35 women had previous or current LN. Among patients who had a renal biopsy, 5 had class 2 (16%), 7 class 3 (23%), 15 class 4 (48%), and 4 class 5 (13%) LN.

Preeclampsia was significantly more likely to develop in women with LN than in women with SLE and no renal involvement (25.7% vs 2.9%), Roza Chaireti, MD, of Karolinska Institutet in Solna, Sweden, and collaborators reported in Lupus. Most of the women in whom preeclampsia developed had class 3 or 4 LN. Having LN also was significantly associated with a high proportion of premature births: 25.6% vs 7.5%. In a separate analysis, preeclampsia significantly correlated with renal flares, premature births, and c-sections, the investigators reported.

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Women with and without LN had comparable duration of SLE (9 years) and age at motherhood (32 years). Women with LN were significantly more likely to have proteinuria early in pregnancy (40.0% vs 0%). They also had significantly higher creatinine (58 vs 50 mmol/L) and lower estimated glomerular filtration rate (eGFR): 98.8 vs 111.5 mL/min/1.73 m2.

With respect to prenatal treatment, women with LN were significantly more likely to receive aspirin (80.0% vs 48.5%), prednisolone (65.7% vs 38.2%), and azathioprine (28.6% vs 10.3%). Combination therapy with aspirin and hydroxychloroquine (HCQ) became more common towards the end of the study period concurrently with reduction in the rates of preeclampsia.

According to Dr Chaireti’s team, “despite broader usage of medications such as HCQ and decrease in the rates of complications such as preeclampsia, pregnancies in women with SLE are still at high risk for obstetric complications. This was particularly obvious in patients with previous or active LN, where the risk for preeclampsia was significantly higher compared to both SLE patients without renal involvement and to the general population.”

The findings support the recommendation to continue and/or initiate treatment with HCQ in all SLE pregnancies, the investigators stated.


Bremme K, Honkanen S, Gunnarsson I, Chaireti R. The presence of lupus nephritis additionally increases the risk of preeclampsia among pregnant women with systemic lupus erythematosus. Lupus. Published online April 12, 2021. doi:10.1177/09612033211004716