SLE can affect these organs and tissues:

• Kidneys

• Joints, muscles, and skin

• Immune system

• Blood

• Brain

• Heart

• Lungs

SLE is diagnosed by both blood tests and symptoms. Multiple blood tests are required to diagnose SLE.

The first step in testing is an antinuclear antibody (ANA) test. This blood test looks for a specific type of antibody in the blood. The presence of these antibodies is a sign of an autoimmune attack on the body’s tissues. This test alone does not diagnose lupus. Other blood tests are needed to help support the diagnosis.

SLE is associated with a higher risk of pregnancy loss, preeclampsia, fetal growth restriction (FGR), and preterm birth.

In rare cases, SLE may affect the fetus. Neonatal lupus erythematosus (NLE) is a rare but serious complication that may result in skin lesions, heart problems, anemia, hepatitis, and blood disorders. Although most of these effects are not permanent, a heart problem called congenital heart block occurs in about one-half of babies with NLE. This condition can cause permanent scarring in the baby’s heart. About 1 in 5 infants who develop this heart problem die within the first three years of life.

If you are pregnant and have SLE, you need special care that includes additional testing, close monitoring, and often changes in medication. You may have the following tests:

1. Blood tests: Testing will be performed regularly throughout your pregnancy and at your first prenatal care visit.

2. Blood pressure and symptom checks: Your blood pressure and symptoms will be watched closely.

3. Ultrasound exams and antenatal testing: In your third trimester, you may have ultrasound exams and tests to monitor fetal well-being.

Some SLE medications should be continued during pregnancy, while others should be avoided. In some cases, new medications may be recommended to prevent complications or to manage flares. Your healthcare provider will review your current medications and make any necessary changes.

Your healthcare provider may recommend that you take low-dose aspirin (81-mg tablet) starting at 12 weeks of pregnancy to lower the risk of preeclampsia.

If you are having SLE symptoms, it may be recommended that you start or continue a medication called hydroxychloroquine. This medication may also have benefits even if you don’t have symptoms. Your pregnancy care provider and rheumatologist will review your symptoms and medical history to see whether this treatment is right for you.

All pregnant people should take folic acid during pregnancy and preferably for 3 months before becoming pregnant.

Pregnancy can increase the risk of organ damage and death in people with SLE. Pregnancy can cause complications such as kidney problems, blood clots, or issues affecting the nervous system. If you had these problems before pregnancy, they may worsen during pregnancy.

Most flares during pregnancy are mild. But 15% to 30% of flares are severe, and some can be life-threatening. Treatment during pregnancy depends on how severe the flare is. Additional medications may be given to manage symptoms and prevent further immune system damage.

Yes. If you are thinking about pregnancy, experts recommend scheduling a pre-pregnancy healthcare visit with your rheumatologist and a maternal-fetal medicine (MFM) subspecialist. This pre-pregnancy visit allows your healthcare providers to:

• Assess your health and discuss the risks that pregnancy might have for you and the fetus.

• Review your medications to decide which ones to continue during pregnancy and whether any should be stopped before you start trying to get pregnant. You should not make any changes in your medications without talking with a healthcare provider.

• Discuss pregnancy timing. If you are having symptoms, your healthcare provider may suggest that you wait until you’ve been symptom-free for at least 6 months before trying to get pregnant. Many birth control methods are safe for people with SLE and can be easily stopped when you want to become pregnant.