WOMEN with systemic lupus erythematosus (SLE) are less likely to have a second delivery and face higher recurrence of adverse pregnancy outcomes, a nationwide Swedish cohort study examining reproductive outcomes in SLE has found.
Pregnancy Challenges in Systemic Lupus Erythematosus
Systemic lupus erythematosus is associated with increased maternal and fetal complications during pregnancy, including preeclampsia and preterm birth. However, limited evidence exists regarding whether women with systemic lupus erythematosus are less likely to pursue additional pregnancies or experience repeat adverse pregnancy outcomes following a first delivery.
Nationwide Cohort Study Examined Repeat Deliveries
Researchers conducted a nationwide population-based cohort study using Swedish registers to identify women with systemic lupus erythematosus who had a first singleton liveborn delivery after diagnosis. Women with systemic lupus erythematosus were matched with up to 10 comparators without lupus according to birth year and residence. Second delivery rates were analysed among women whose first delivery occurred between 2003–2020, with follow-up extending to the end of 2021. Recurrence analyses included women with two deliveries between 2003–2022.
Higher Recurrence of Complications Observed
Second delivery rates were analysed in 543 women with systemic lupus erythematosus and 17,218 comparators. Over a median follow-up of 2.3 years, incidence rates of second delivery were 156 versus 176 per 1,000 person-years among women with and without systemic lupus erythematosus, respectively, corresponding to an adjusted hazard ratio of 0.89 (95% CI 0.80–0.99). Among women who experienced at least one adverse pregnancy outcome during their first pregnancy, the adjusted hazard ratio for second delivery was 0.78 (95% CI 0.63–0.96). Women with systemic lupus erythematosus also demonstrated higher recurrence risks for preeclampsia (RR 1.38), preterm delivery (RR 2.31), and any adverse pregnancy outcome overall (RR 1.54).
Need for Individualised Reproductive Counselling
The authors concluded that systemic lupus erythematosus may influence future reproductive decisions and increase the likelihood of repeated pregnancy complications. They emphasised the importance of tailored counselling, careful pregnancy planning, and close obstetric monitoring to support maternal and neonatal outcomes in women living with lupus.
Reference
Antovic A et al. Second delivery rates and recurrence of adverse pregnancy outcomes in women with systemic lupus erythematosus: a nationwide population-based cohort study. Rheumatology. 2026;keag243.
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