# Temporal trends in lupus pregnancy over four decades in a referral centre: pregnancy planning and hydroxychloroquine use are associated with improved outcomes

## TL;DR

Over four decades, pregnancy outcomes in women with lupus improved, especially with planned pregnancies and use of hydroxychloroquine.

## Contribution

The study identifies pregnancy planning and hydroxychloroquine use as key factors in improving outcomes for lupus pregnancies.

## Key findings

- Planned pregnancies were associated with lower flare risk and higher live birth rates.
- Hydroxychloroquine use during pregnancy reduced flare risk independently.
- Pregnancy management and outcomes improved over time, with fewer fetal complications after 2016.

## Abstract

To evaluate temporal trends in pregnancy management and outcomes in women with SLE and explore the impact of pregnancy planning on maternal and foetal complications.

We conducted a retrospective study including women with SLE with one or more pregnancies after diagnosis or diagnosed during pregnancy. Data were collected through questionnaires and medical records. To assess temporal trends, the study period (1985–2024) was divided into five intervals with similar pregnancy and patient distribution. Using generalized estimating equations, we identified risk factors for adverse pregnancy outcomes and evaluated temporal trends in pregnancy characteristics.

We recorded 109 pregnancies from 65 women; 70.6% resulted in live births. Planned pregnancies were associated with a lower flare risk [odds ratio (OR) 0.31 (95% CI 0.11, 0.89)] and a higher likelihood of live birth [OR 3.31 (95% CI 1.41, 7.8)]. HCQ use during pregnancy was independently associated with a reduced flare risk [OR 0.26 (95% CI 0.08, 0.8)]. Pregnancies before 2005 were less often planned [OR 0.10 (95% CI 0.03, 0.4)], while HCQ use during pregnancy increased over time [OR 0.56 (95% CI 0.34, 0.95), for the period 1985–2005 vs 2021–2024], with discontinuation decreasing from 33% to <2%. The predicted probability of preventive aspirin use in patients without antiphospholipid syndrome increased from 12% before 2005 to 46% in 2021–2024, whereas continuous glucocorticoid use decreased from 58% before 2005 to 16% after 2020. The probability of foetal complications showed a decreasing trend after 2016.

Pregnancy management and outcomes improved over time in SLE; planned pregnancy and HCQ use were associated with favourable results.