{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T10:20:02Z","timestamp":1792405202478,"version":"4.4.0"},"reference-count":86,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:p>Systemic lupus erythematosus (SLE), a multiorgan systemic inflammatory disorder, predominantly affects women during their reproductive years. In this review, we summarize the state of knowledge about preconception planning and management of SLE during pregnancy. Achieving remission or low disease activity for several months on medications compatible with pregnancy prior to conception is essential to decreasing the risk of disease flare and improving pregnancy outcomes, including pre\u2010eclampsia, preterm birth, and intrauterine growth restriction. With close management and well\u2010controlled disease before and during pregnancy, &lt;10% of patients flare. All patients with SLE should remain on hydroxychloroquine unless contraindicated. Expectant mothers with a history of antiphospholipid syndrome should be treated with anticoagulant therapy during pregnancy. Women with anti\u2010Ro\/SSA or anti\u2010La\/SSB antibodies require additional monitoring because their offspring are at increased risk for congenital heart block. Patients with SLE should be offered low\u2010dose aspirin starting at the end of the first trimester to reduce the risk of pre\u2010eclampsia. Flares of SLE during pregnancy require escalation of therapy. The immunosuppressives azathioprine, tacrolimus, and cyclosporine are compatible with pregnancy, and biologic agents can also be considered. Glucocorticoid use in pregnancy should be limited to the lowest effective dose. Mycophenolate mofetil\/mycophenolic acid, methotrexate, leflunomide, and cyclophosphamide are known to be teratogenic and are contraindicated in pregnancy. Distinguishing a flare of lupus nephritis during pregnancy from pre\u2010eclampsia can be particularly challenging. Overall, outcomes in pregnancy for women with lupus are improving, but gaps in knowledge about optimal management strategies persist.<\/jats:p>","DOI":"10.1002\/art.42756","type":"journal-article","created":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T03:27:23Z","timestamp":1700191643000},"page":"321-331","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Expert Perspective on a Clinical Challenge: Lupus and Pregnancy"],"prefix":"10.1002","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7820-0091","authenticated-orcid":false,"given":"Laura","family":"Tarter","sequence":"first","affiliation":[{"name":"Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1007-4084","authenticated-orcid":false,"given":"Bonnie L.","family":"Bermas","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center  Dallas Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"key":"e_1_2_1_6_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/35.2.133"},{"key":"e_1_2_1_6_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2235"},{"key":"e_1_2_1_6_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-016-3270-5"},{"key":"e_1_2_1_6_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203310397967"},{"key":"e_1_2_1_6_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0104375"},{"key":"e_1_2_1_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.21663"},{"key":"e_1_2_1_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.03.012"},{"key":"e_1_2_1_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2020.01.014"},{"key":"e_1_2_1_6_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-211641"},{"key":"e_1_2_1_6_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203310378669"},{"key":"e_1_2_1_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2016.07.010"},{"key":"e_1_2_1_6_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/M19-0120"},{"issue":"9","key":"e_1_2_1_6_14_1","first-page":"1709","article-title":"Decrease in pregnancy loss rates in patients with systemic lupus erythematosus over a 40\u2010year period","volume":"32","author":"Clark CA","year":"2005","journal-title":"J Rheumatol"},{"key":"e_1_2_1_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.02.104"},{"key":"e_1_2_1_6_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203308097575"},{"key":"e_1_2_1_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.41191"},{"key":"e_1_2_1_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2019.09.002"},{"key":"e_1_2_1_6_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212535"},{"key":"e_1_2_1_6_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22159"},{"key":"e_1_2_1_6_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.13830"},{"key":"e_1_2_1_6_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203319843343"},{"key":"e_1_2_1_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.09.007"},{"key":"e_1_2_1_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.12.1218"},{"key":"e_1_2_1_6_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.42015"},{"key":"e_1_2_1_6_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaa592"},{"key":"e_1_2_1_6_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211208"},{"key":"e_1_2_1_6_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.120.008686"},{"key":"e_1_2_1_6_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.11304"},{"key":"e_1_2_1_6_30_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa031855"},{"key":"e_1_2_1_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(73)90559-0"},{"key":"e_1_2_1_6_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01216.x"},{"issue":"5","key":"e_1_2_1_6_33_1","first-page":"2535","article-title":"National Transplantation Pregnancy Registry: analysis of outcome\/risks of 394 pregnancies in kidney transplant recipients","volume":"26","author":"Armenti VT","year":"1994","journal-title":"Transplant Proc"},{"key":"e_1_2_1_6_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2004.04140.x"},{"key":"e_1_2_1_6_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3453"},{"key":"e_1_2_1_6_36_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V391575"},{"key":"e_1_2_1_6_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203317749046"},{"issue":"4","key":"e_1_2_1_6_38_1","first-page":"561","article-title":"Medication use among pregnant women with systemic lupus erythematosus and general population comparators","volume":"56","author":"Palmsten K","year":"2017","journal-title":"Rheumatology (Oxford)"},{"key":"e_1_2_1_6_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.21224"},{"key":"e_1_2_1_6_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trsl.2020.04.006"},{"key":"e_1_2_1_6_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaa857"},{"key":"e_1_2_1_6_42_1","first-page":"1687","article-title":"2023 ACR\/EULAR antiphospholipid syndrome classification criteria","volume":"75","author":"Barbhaiya M","year":"2023","journal-title":"Ann Rheum Dis"},{"key":"e_1_2_1_6_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60712-0"},{"issue":"10","key":"e_1_2_1_6_44_1","article-title":"Antiplatelet agents for preventing pre\u2010eclampsia and its complications","volume":"2019","author":"Duley L","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_1_6_45_1","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2003.233"},{"key":"e_1_2_1_6_46_1","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200108)44:8<1832::AID-ART320>3.0.CO;2-C"},{"key":"e_1_2_1_6_47_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2020.607515"},{"key":"e_1_2_1_6_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00161-2"},{"key":"e_1_2_1_6_49_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780361114"},{"key":"e_1_2_1_6_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24768"},{"key":"e_1_2_1_6_51_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.033894"},{"key":"e_1_2_1_6_52_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.27333"},{"key":"e_1_2_1_6_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.02.042"},{"key":"e_1_2_1_6_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3083.2011.02610.x"},{"key":"e_1_2_1_6_55_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.023000"},{"key":"e_1_2_1_6_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(00)01048-2"},{"key":"e_1_2_1_6_57_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ker515"},{"key":"e_1_2_1_6_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.05.045"},{"key":"e_1_2_1_6_59_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20214"},{"key":"e_1_2_1_6_60_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437597.44550.5d"},{"key":"e_1_2_1_6_61_1","doi-asserted-by":"publisher","DOI":"10.1022\/art.42733"},{"key":"e_1_2_1_6_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.06.040"},{"key":"e_1_2_1_6_63_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13338"},{"key":"e_1_2_1_6_64_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-216114"},{"key":"e_1_2_1_6_65_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S282604"},{"key":"e_1_2_1_6_66_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.127376"},{"key":"e_1_2_1_6_67_1","doi-asserted-by":"publisher","DOI":"10.5830\/CVJA-2016-021"},{"issue":"11","key":"e_1_2_1_6_68_1","first-page":"1164","article-title":"Pregnancy and the erythrocyte sedimentation rate","volume":"108","author":"Broe NR","year":"2001","journal-title":"BJOG"},{"key":"e_1_2_1_6_69_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.02084"},{"key":"e_1_2_1_6_70_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-021-00984-1"},{"key":"e_1_2_1_6_71_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12111"},{"key":"e_1_2_1_6_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semnephrol.2017.05.006"},{"key":"e_1_2_1_6_73_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpme.1996.24.3.243"},{"issue":"7","key":"e_1_2_1_6_74_1","first-page":"2244","article-title":"Reduction of extracellular matrix protein expression in human amnion epithelial cells by glucocorticoids: a potential role in preterm rupture of the fetal membranes","volume":"80","author":"Guller S","year":"1995","journal-title":"J Clin Endocrinol Metab"},{"key":"e_1_2_1_6_75_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar1957"},{"key":"e_1_2_1_6_76_1","doi-asserted-by":"publisher","DOI":"10.1002\/1096-9926(200012)62:6<385::AID-TERA5>3.0.CO;2-Z"},{"key":"e_1_2_1_6_77_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60695-4"},{"key":"e_1_2_1_6_78_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215089"},{"key":"e_1_2_1_6_79_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203314540353"},{"key":"e_1_2_1_6_80_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199708270-00002"},{"key":"e_1_2_1_6_81_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000117564.50117.FB"},{"key":"e_1_2_1_6_82_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200012270-00010"},{"key":"e_1_2_1_6_83_1","doi-asserted-by":"publisher","DOI":"10.1177\/09612033221148334"},{"key":"e_1_2_1_6_84_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-07-295444"},{"key":"e_1_2_1_6_85_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-222505"},{"issue":"10","key":"e_1_2_1_6_86_1","first-page":"1426","article-title":"The effects of rituximab treatment during pregnancy on a neonate","volume":"91","author":"Friedrichs B","year":"2006","journal-title":"Haematologica"},{"key":"e_1_2_1_6_87_1","doi-asserted-by":"publisher","DOI":"10.1191\/0961203305lu2169oa"}],"container-title":["Arthritis &amp; Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/art.42756","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T17:47:22Z","timestamp":1759945642000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/art.42756"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,9]]},"references-count":86,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1002\/art.42756"],"URL":"https:\/\/doi.org\/10.1002\/art.42756","archive":["Portico"],"relation":{},"ISSN":["2326-5191","2326-5205"],"issn-type":[{"value":"2326-5191","type":"print"},{"value":"2326-5205","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,9]]},"assertion":[{"value":"2023-09-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}