Abstract
<title>Abstract</title> <p>Background: Pregnancy outcomes in women with systemic lupus erythematosus (SLE) have improved substantially over the last two decades owing to advances in multidisciplinary care. However, the contemporary burden of obstetric complications remains incompletely defined. This study evaluated pregnancy outcomes in a tertiary referral cohort and compared them with nationwide population data. Methods: This retrospective cohort study included 87 pregnancies in women with SLE followed at the Institute for the Care of Mother and Child between 2016 and 2023. Key outcomes assessed included hypertensive disorders of pregnancy (gestational hypertension – GHT, preeclampsia – PEE), gestational diabetes mellitus (GDM), fetal growth restriction (FGR), preterm birth, and mode of delivery. Outcomes were compared with data from the 2023 Czech National Registry of Reproductive Health (NRRZ) and a historical cohort (2001–2018). Multivariable logistic regression analysis was performed to identify independent predictors of preterm birth. Results: Rates of gestational hypertension (4.6%) and preeclampsia (6.9%) were comparable with those in the general population, representing a substantial decline compared to the historical cohort (GHT 35%, PEE 11%). The rate of GDM was numerically lower than in the general population (6.9% vs. 11.1%; p = 0.30). Preterm birth < 37 weeks occurred in 13.8% of cases (vs. 6.4% in the population; p = 0.013). Early preterm birth (< 34 weeks) was uncommon (3.4% vs. 1.0%; p = 0.057). The rate of cesarean sections was significantly higher (51.7% vs. 26%; p < 0.001). Antiphospholipid syndrome (APS) was associated with a 42.9% rate of preterm birth (p = 0.003) and was identified as a strong independent predictor of prematurity (aOR 7.21; 95% CI 1.79–29.08; p = 0.005). Conclusion: Modern multidisciplinary care has substantially improved pregnancy outcomes in women with SLE, bringing most maternal complications close to population levels, although APS remains the principal determinant of adverse perinatal outcome.</p>