Temporal trends in lupus pregnancy over four decades in a referral center: pregnancy planning and hydroxychloroquine use are associated with improved outcomes

Objective To evaluate temporal trends in pregnancy management and outcomes in women with systemic lupus erythematosus (SLE) and explore the impact of pregnancy planning on maternal and fetal complications. Methods Retrospective study including women with SLE with ≥1 pregnancy after diagnosis or diagnosed during pregnancy. Data were collected through questionnaires and medical records. To assess temporal trends, the study period (1985–2024) was divided into five intervals with similar pregnancy and patient distribution. Using Generalized Estimating Equations, we identified risk factors for adverse pregnancy outcomes and evaluated temporal trends in pregnancy characteristics. Results We recorded 109 pregnancies from 65 women; 70.6% resulted in live births. Planned pregnancies were associated with a lower flare risk (OR 0.31, 95% CI 0.11–0.89) and a higher likelihood of live birth (OR 3.31, 95% CI 1.41–7.8). Hydroxychloroquine use during pregnancy was independently associated with reduced flare risk (OR 0.26, 95% CI 0.08–0.8). Pregnancies before 2005 were less often planned (OR 0.10, 95% CI 0.03–0.4), while hydroxychloroquine use during pregnancy increased over time (OR 0.56, 95% CI 0.34–0.95, for the period 1985–2005 versuss 2021–2024), with discontinuation decreasing from 33% to < 2%. The predicted probability of preventive aspirin use in patients without antiphospholipid syndrome increased from 12% before 2005 to 46% in 2021–2024, whereas continuous glucocorticoid use decreased from 58% before 2005 to 16% after 2020. The probability of fetal complications showed a decreasing trend after 2016. Conclusion Pregnancy management and outcomes improved over time in SLE, while planned pregnancy and hydroxychloroquine use were associated with favorable results.