From Infertility to Pregnancy: Understanding the Reproductive Risks and Care for Women with Systemic Lupus Erythematosus
Author(s): Anastasia V. Poznyak, Nikita Aleksandrovich Mitkin, Elizaveta Romanovna Korchagina, Olga Nikolaevna Maltseva, Aleksandra Sergeevna Utkina and Alexander N. Orekhov
Abstract
Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease affecting multiple systems, particularly the kidneys, skin, and reproductive health. This review examines the intersection of SLE, fertility, and reproductive outcomes in women, highlighting the increased prevalence of infertility in this population. Notably, women with SLE experience significant reproductive challenges, including higher rates of pregnancy loss and complications during pregnancy, such as preeclampsia and infections. Indirect factors, such as the impact of cytotoxic medications like cyclophosphamide, along with psychological and lifestyle influences, contribute to decreased fertility and complicate family planning. Direct disease-related factors, including altered ovarian reserve and menstrual irregularities linked to SLE activity, are also explored. Additionally, antiphospholipid antibodies can play a role in fertility and pregnancy outcomes, emphasizing the need for comprehensive management strategies. Fertility preservation strategies, particularly critical for those undergoing immunosuppressive therapies, are discussed alongside the necessary monitoring and management of SLE during pregnancy and postpartum. This review underscores the importance of an interdisciplinary approach in the care of women with SLE, from preconception counseling through pregnancy and postpartum care, to optimize both maternal and fetal health outcomes.