Lacerda MI, de Jesús GRR, dos Santos FC, et al. - According to this retrospective cohort study, patients with systemic lupus erythematosus (SLE) who are pregnant and have irreversible damage accrual may have a higher risk of maternal and fetal adverse outcomes, regardless of disease activity.

• This investigation was carried out at the Hospital University Pedro Ernesto of the State University of Rio de Janeiro, Brazil.

• The SLICC/ACR damage index (SDI) was used to define irreversible damage.

• Data were analyzed from 260 patients in their first pregnancies after SLE diagnosis, with a quarter of them (67/260) scoring one or more points on SDI at the start of prenatal care.

• These individuals had more unfavourable maternal outcomes, such as disease activity throughout pregnancy and puerperium, active lupus nephritis, and hospitalizations than those who did not have an SDI score.

• Similarly, even after controlling for disease activity (SLEPDAI > 4), the chances of unfavourable fetal and neonatal outcomes were increased in patients with SDI ≥ 1.

• Patients with SDI ≥ 1 had a higher rate of preterm deliveries, small for gestational age infants, and neonatal intensive care unit admission.

• The multivariate analyses revealed that SDI ≥ 1 is an independent risk factor for hospitalization owing to obstetric complications and preterm delivery.