Family planning and pregnancy are important and usually problematic issues
for a young woman with lupus nephritis. Moderate renal insufficiency and pr
evious use of alkylating cytotoxic drugs are associated with decreased fert
ility. Oral contraceptives containing synthetic estrogens are contraindicat
ed in women with active lupus nephritis, uncontrolled hypertension, history
of thromboembolic diseases or high levels of antiphospholipid antibodies.
Mild flares of systemic lupus erythematosus (SLE) are common during pregnan
cy, severe renal flares and permanent impairment of renal function are unco
mmon. The outlook of pregnancy for women with lupus nephritis is usually fa
vourable if the disease (both renal and nonrenal) has been quiescent for at
least 6 months before pregnancy, and if, at conception, serum creatinine i
s less than 140 mu mol/l, proteinuria less than 3 g/24 h and blood pressure
controlled. The risk of fetal loss is, however, at least 2-3 times higher
than in the normal population and pre-eclampsia, prematurity and fetal grow
th retardation frequently complicate these pregnancies. Especially poor fet
al outcome is associated with antiphospholipid antibodies. Pregnancies in w
omen with lupus nephritis require intense fetal and maternal surveillance.