Objective:

To review maternal and fetal risks, and neurologic complications in peri-partum patients with Systemic lupus erythematosus (SLE), Sjögren’s syndrome (SS) , Sarcoidosis and Behçet’s disease (BD).  

Background:

SLE, SS, sarcoidosis, and BD affect women of reproductive age and may complicate pregnancy. Peri-partum neurologic involvement may be clinically significant, but has poorly defined pregnancy outcomes.

Design/Methods:

A PubMed review (2010–2025) included observational, cohort, case–control, and case series studies, excluding reviews.  Data on maternal, and fetal complications, and neurologic involvement was assessed.

Results:

Thirty-seven relevant studies were identified. Only one study specifically correlated pre-partum neurologic involvement and pregnancy outcomes.

Maternal outcomes showed significantly increased risks of preeclampsia, rheumatologic disease flares, preterm labor, and thromboembolism (SLE, SS, sarcoidosis), and higher rate of cesarean deliveries (sarcoidosis).

Fetal outcomes: Prematurity and intrauterine growth restriction were common in SLE, SS, and sarcoidosis. SLE had additional risks of neonatal lupus and congenital heart block.

BD outcomes were generally favorable.

Therapeutics: Hydroxychloroquine reduced flares and neonatal complications in SLE and SS. Aspirin and anticoagulation improved outcomes in women with antiphospholipid antibodies (SLE) and BD with comorbid vascular disease.

Neurologic involvement: Eleven studies reported seizures, strokes, venous sinus thrombosis, demyelinating syndromes, and neuropsychiatric complications (SLE, SS, sarcoidosis), without outcome stratification. Recent multicenter study showed that neuropsychiatric SLE was independently linked to significantly worse maternal (seizures, preeclampsia, thrombosis) and fetal (IUGR, preterm birth, pregnancy loss) outcomes, highlighting neurologic involvement as a distinct risk factor.

Conclusions:

Pregnancy in autoimmune systemic rheumatologic diseases carries a high risk of adverse outcomes. Although neurologic involvement is prevalent and serious, it is seldom recognized independently when assessing risks to reproductive outcomes. The absence of prospective, stratified data limits clinical and therapeutic guidance in this area. Future research should explore whether comorbid neurologic involvement contributes independently to poor pregnancy outcomes in this patient population.