With the in-depth research on the pathogenesis of SLE and the progress of treatment, SLE has changed from a lethal disease to a chronic disease with long-term survival. According to the literature, the 5-year survival rate of SLE can reach 87.2% and the survival rate of more than 10 years can reach 65.2%. Therefore, fertility has become a concern for SLE patients and a clinical problem that the majority of clinicians must face. However, a large number of clinical observations have revealed that pregnancy and childbirth, which are normal physiological processes in healthy people, become a pathological condition in SLE patients. According to data from the U.S. SLE patient registry database, in the United States, SLE patients have about 4,500 pregnancies per year, but 1/3 of them require cesarean delivery to terminate the pregnancy, 33% of the mothers have preterm delivery, more than 20% have complications of eclampsia, and nearly 30% of the fetuses develop intrauterine growth retardation (IUGR); information from Peking Union Medical College Hospital shows that in 78 pregnancies in SLE patients, 18 required therapeutic induction of labor and abortion, with a neonatal mortality rate of 3.8% and a perinatal mortality rate of up to 5.1% in SLE pregnant women, all these data indicate that the delivery process in SLE patients is a pathological one and pregnancies in SLE patients are high-risk pregnancies. Timing and contraindications to pregnancy Patients with SLE must meet the following conditions at the same time: stable disease for at least 6 months, 24-hour urine protein quantification of 0.5 grams or less, oral glucocorticoid dose of 15 mg/day (or equivalent dose of other doses of glucocorticoids) or less, no serious organ damage, and discontinuation of immunosuppressive drugs for more than six months. The following patients are contraindications to SLE pregnancy: 1) severe pulmonary hypertension (estimated pulmonary artery systolic pressure above 50 mmHg, or clinical signs of pulmonary hypertension); 2) severe restrictive pulmonary pathology (FVC <1 liter); 3) cardiac failure; 4) chronic renal insufficiency (serum creatinine level >2.8 mg/dL); 5) previous severe pre-eclampsia or even patients with HELLP syndrome (hemolysis, elevated liver enzymes, thrombocytopenia) that cannot be controlled even after heparin and aspirin therapy; 6) patients who have had a stroke within the past 6 months; 7) patients who have had severe SLE disease activity within the past 6 months. Contraceptive measures Birth control in SLE patients should be planned and under the guidance of a physician. Contraception is one of the important treatment measures for patients with SLE of childbearing age, especially for patients with moderately or severely active disease, and strict contraceptive measures must be used. The intrauterine device (IUD) is one of the most commonly used contraceptive measures in China, and it is safe to use for those patients who have only a single sexual partner and who are taking oral glucocorticoids at doses equivalent to prednisone 10 mg/day or less.The results of the SELENA study showed that the use of progestin-based contraceptives not only reduced the number of disease recurrences in SLE patients, but also treated the more common SLE patients of ovarian cysts, and also reduces osteoporosis caused by glucocorticoid administration, so the use of progestin-based contraceptives is recommended for contraception in SLE patients. However, they are contraindicated in patients with a previous history of thrombosis, active SLE, and positive antiphospholipid antibodies. Medication use during pregnancy Patients with SLE may develop clinical symptoms during pregnancy or require medication if there is a relapse of the disease. Acetaminophen may be used in cases of joint pain or other painful symptoms; NSAIDs are used only in mid-pregnancy because of the risk of miscarriage in early pregnancy and premature fetal ductus arteriosus in late pregnancy. Prednisone or methylprednisolone may be used when the patient has a relapse or needs to maintain the disease in a stable state, and fluorinated glucocorticoids are contraindicated because they can pass through the placenta and affect fetal development and should be used only when needed to treat fetal disease; clinical observations and animal studies have shown that hydroxychloroquine is safe for pregnancy and can reduce the risk of thrombosis in patients with antiphospholipid Although azathioprine belongs to the US FDA pregnancy drug class D, it can be considered for use in SLE patients in pregnancy for the purpose of disease control; intravenous immunoglobulin infusion is also safe and can be used for some patients who need treatment for disease activity; morte-macrolimus, leflunomide, methotrexate, cyclophosphamide, and methotrexate are also safe for use in SLE patients. Methotrexate, cyclophosphamide, and salazosulfapyridine are prohibited drugs because of their teratogenic effects; cyclosporine also belongs to the US FDA pregnancy drug class D. It can be considered when important organ damage and serious hematologic abnormalities occur during pregnancy in SLE patients, but should be used with caution. Close monitoring after pregnancy The recommended follow-up frequency is every 4-6 weeks during the first 20 weeks of pregnancy, every 2 weeks from the 20th to 28th week of pregnancy, and once a week from the 28th week to the end of pregnancy. Ultrasound examination is an important monitoring tool and is performed during the 16th to 20th week of pregnancy for early detection of fetal abnormalities and malformations. Ultrasound should be performed every 4 weeks after 21 weeks of gestation to monitor fetal growth and development, and every 3 weeks if intrauterine growth retardation is suspected. Indications for termination of pregnancy and choice of way to end the pregnancy Termination of pregnancy in SLE patients can be required due to some abnormalities in the SLE patient itself or in the fetus. In the case of SLE patients, termination of pregnancy should be considered in the following cases: 1) significant disease activity in the first 3 months of pregnancy, especially if there is significant organ damage or severe recurrence of the disease; 2) patients with severe gestational hypertensive syndrome; 3) patients with lupus encephalopathy, such as prominent psychiatric symptoms or cerebrovascular accidents; 4) patients with cardiac failure; 5) patients with severe interstitial lung changes leading to respiratory failure; and 6) recurrence of lupus nephritis with 24-hour urine protein quantification greater than 3 grams with severe swelling; early termination of pregnancy should also be performed if the fetus is 1) found to have low placental function during pregnancy monitoring and the fetus is already mature; 2) fetal intrauterine hypoxia or fetal growth restriction that does not improve with active treatment. The mode of termination of pregnancy can be chosen according to the size of the fetus, and in principle, the advice of the obstetrician should be followed. Since the condition of SLE patients can change rapidly in the second trimester, termination of pregnancy can be considered after fetal maturity and the indications for cesarean delivery can be relaxed appropriately, but recent studies have shown that SLE patients can deliver spontaneously as healthy pregnant women. Management of pregnancy in patients with SLE combined with antiphospholipid syndrome The management of patients with SLE combined with APS is complex and needs to be differentiated according to the patient’s previous clinical history. If the patient is positive for antiphospholipid antibodies but has no history of adverse pregnancy or thrombosis, then only a low dose of aspirin should be given at the time of pregnancy and aspirin can be given until after the patient delivers; if the patient has a previous history of thrombosis, then warfarin should be started before pregnancy to maintain the international normal ratio (INR) between 2 and 3, but because warfarin is teratogenic If the patient has a moderate to high titer of antiphospholipid antibodies and has had two to three or more fetal losses in the first 12 weeks of pregnancy, or one or more stillbirths, or one or more preterm deliveries due to placental insufficiency, then a therapeutic dose of heparin should be used after pregnancy is established instead of warfarin. prophylactic dose of heparin until 6 weeks after delivery. It is currently recommended to start heparin therapy when the patient has a delayed menstrual period, when pregnancy is considered a possibility, and if possible, to use low molecular heparin because it does not require INR monitoring and because it has a lower risk of heparin-related thrombocytopenia than regular heparin and reduces the incidence of osteoporosis. Heparin can be changed to warfarin anticoagulation therapy 6 weeks after delivery. Diagnosis and treatment of neonatal lupus Women with SLE who are positive for anti-SSA or anti-SSB antibodies can have these two antibodies in their blood pass through the placenta to the fetus after pregnancy, causing neonatal lupus. In addition to the skin rash and mild hematologic abnormalities that appear after birth, the most important abnormality is fetal cardiac conduction, which usually manifests as atrioventricular block of degree II or higher. Early detection and treatment may reverse the block. According to the data from the International Neonatal Lupus Registry, only 26.9% of neonatal lupus cases have rashes and 3.2% have hematologic abnormalities, but up to 61% have heart block, and the risk of fetal neonatal lupus after another pregnancy is nearly 10 times higher in mothers with SLE who have delivered a fetus with neonatal lupus than in mothers who have not delivered a fetus with neonatal lupus. The risk of fetal neonatal lupus after a second pregnancy is nearly 10 times higher than that of mothers who have not delivered a fetus with neonatal lupus. The mortality rate of fetuses with neonatal lupus is as high as 20%. It is now known that fetal heart block can be detected early by fetal cardiac ultrasound between the 16th and 24th weeks of gestation, and that medications can be used to treat definite AV block, which may disappear in some fetuses. Some studies have shown that oral dexamethasone given to pregnant women with SLE who have fetuses with AV block can reverse the AV block in some children, and intravenous immunoglobulin infusion has also been reported to be effective, but reports on the efficacy of betamethasone are inconsistent and further studies are needed. In conclusion, pregnancy in SLE patients is a high-risk pregnancy, and pregnancy and SLE disease interact with each other. Therefore, strict control of the timing of pregnancy, contraindications, good family planning, close monitoring during pregnancy, and close cooperation with obstetricians are the keys and guarantees that SLE patients can successfully pass the pregnancy process.