What are the adverse effects of pregnancy and childbirth on lupus erythematosus? Lupus erythematosus predominates in women of childbearing age, with a relatively low prevalence in prepubertal and postmenopausal women. The reason for this is that estrogen plays an important role in the development of lupus erythematosus. The changes in sex hormones that occur during pregnancy, especially the elevated levels of estrogen and lactogen, cause the body’s immune response to continue to increase, thus leading to an increase in lupus erythematosus activity and symptoms. On the other hand, due to the metabolic needs of the fetus during pregnancy, the patient’s heart and kidney burden increases and she is in a state of stress, which is another factor that causes lupus flare-ups. The exacerbation of lupus is mostly seen in the middle and late stages of pregnancy and early puerperium (i.e., 4 weeks after delivery), and according to the literature, the rate of worsening of lupus erythematosus during pregnancy is 16. 7 to 54 .3%. Does lupus erythematosus affect the fetus? Lupus erythematosus also affects the fetus. The main manifestations are abnormal pregnancies, such as miscarriage, premature birth, intrauterine malnutrition and stillbirth. These abnormalities are mainly related to the presence of a group of antiphospholipid antibodies in the blood of lupus patients. These antibodies interact with placental vascular endothelial cells to block blood vessels and cause placental infarction and intrauterine fetal distress. Secondly, some drugs used to treat lupus, such as high-dose hormones and immunosuppressants, can also affect the normal development of the fetus. From the above two aspects, the interaction between lupus erythematosus and pregnancy makes pregnancy and childbirth in lupus patients risky and indeed a major problem. So, is it true that lupus patients cannot have children? No, not at all. Can a person with lupus get pregnant? When should I get pregnant? In the past, absolute contraception was required for lupus patients, and pregnancy and childbirth were contraindicated. It has been reported that few lupus patients abroad had pregnancy before the 1950s. However, with the improvement of medical treatment, the prognosis of pregnancy in lupus erythematosus has been greatly improved. In recent years, some scholars have proposed to “let lupus patients live like healthy people and have children like healthy people”. Improving the quality of life of lupus erythematosus patients is the long-term goal of our treatment. There is no unified standard as to when the risk of pregnancy and childbirth is relatively low in lupus patients. It is generally accepted that pregnancy should be considered only after the disease has been in remission, i.e., after a long period of sustained stability. The specific conditions are: (1) The disease has been in remission for at least 1 year after regular treatment. (2) The dose of medication used for maintenance therapy is low (prednisone ≤ 10 mg/d). (3) No serious organ lesions due to lupus erythematosus. (4) Discontinuation of immunosuppressive drugs and other drugs that may affect fetal development. Pregnancy is not recommended for those with active disease or progressive heart, lung, brain or kidney damage. Those with active disease before pregnancy are prone to deterioration after pregnancy. The longer the number of years in remission, the lower the rate of deterioration. Some studies have analyzed that those who have been in remission for more than 3 years have a significantly lower rate of deterioration after pregnancy than those whose disease has been stable for less than 3 years. What are the countermeasures to improve the safety of lupus patients during pregnancy and childbirth? Patients with lupus erythematosus who are pregnant must be followed up regularly and monitored closely under the joint care of rheumatologists and obstetricians. To prevent deterioration of the disease during pregnancy and postpartum, take prednisone therapy as needed during pregnancy. The fetus is protected because the placenta produces an enzyme (11-в-dehydrogenase) that oxidizes prednisone entering the placenta from the maternal circulation to an inactive form. Therefore, the mother’s administration of prednisone has little effect on the fetus. However, some hormones, such as dexamethasone, can cross the placental barrier to affect the fetus and should be avoided. Prednisone 10 mg/d is usually given to patients with lupus in remission, and the dosage of prednisone is increased according to the change of the disease. The hormone dosage should be increased at the time of delivery, commonly methylprednisolone 60-80mg intravenously, methylprednisolone 40mg intravenously on the second day after delivery, and resume the prenatal dose on the third day, at least 10mg/d, and maintain for 6 weeks, depending on the development of the disease, bromelain stop and immunosuppressants can also be added. For pregnant women with a history of habitual abortion and positive antiphospholipid antibodies, oral low-dose aspirin (50 mg/d) is recommended to prevent miscarriage or stillbirth. As can be seen, despite the risks associated with pregnancy and childbirth in patients with lupus erythematosus, the medical community has now accumulated considerable experience in this area. Patients with lupus like Xiaoqian can consider pregnancy if their disease continues to stabilize and fulfill a dream of becoming a mother. Of course, the patient should be monitored jointly by a rheumatologist and an obstetrician.