LÚPUS E GRAVIDEZ: RISCOS, CUIDADOS E ORIENTAÇÕES PARA UMA GESTAÇÃO SEGURA

Systemic Lupus Erythematosus (SLE) is a chronic, multisystem autoimmune disease that primarily affects women of reproductive age. Its incidence is higher among Afro-descendant, Hispanic, and Asian women, and the female-to-male prevalence ratio is 9:1, suggesting a strong influence of sex hormones on the pathogenesis of the disease. Pregnancy in women with SLE poses a clinical challenge, as the disease can negatively impact gestation, while pregnancy can also exacerbate lupus activity. The risk of obstetric complications, such as miscarriage, preterm birth, fetal growth restriction, and preeclampsia, is significantly higher in these patients. Moreover, the presence of autoantibodies, such as antiphospholipids, increases the likelihood of thrombosis and pregnancy loss. Symptoms of SLE during pregnancy are variable and often overlap with normal physiological changes of pregnancy. Among the most common manifestations are fatigue, arthralgia, myalgia, fever, skin lesions, and hematological changes such as anemia and thrombocytopenia. Lupus nephropathy is one of the most severe complications, potentially leading to renal failure and directly affecting maternal and fetal well-being. Differential diagnosis between lupus activity and preeclampsia is essential for proper management, with laboratory tests such as complement levels (C3 and C4) and anti-DNA antibody testing being crucial for this distinction. The prognosis of pregnancy in women with SLE is directly related to the disease state before conception. Studies indicate that remission for at least six months prior to pregnancy significantly reduces maternal-fetal risks. Appropriate treatment should include pregnancy-compatible medications such as hydroxychloroquine and anticoagulants for patients with antiphospholipid syndrome. Multidisciplinary follow-up is essential to minimize risks and ensure a safer pregnancy. Preconception planning and continuous monitoring of disease activity are key strategies to improve obstetric outcomes and reduce maternal-fetal morbidity.