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Objective-To study maternal and fetal outcome in women with past or present histologically proven systemic lupus erythematosus (SLE) nephritis. Method-Retrospective study of 32 pregnancies in 22 women with past or present histologically proven SLE nephritis in a single French centre. Results-Pregnancy (25 planned and 7 not planned) occurred in a mean (SD) of 8 (5) years after SLE diagnosis and 6 (4) years after renal disease onset. Seven occurred in women with antiphospholipid syndrome. At pregnancy onset, all but one woman had creatininaemia below 100 µmol/l, five had proteinuria >0.5 g/day, none had hypertension. Twelve pregnancies occurred in women previously treated with immunosuppressant drugs. Treatment comprised prednisone (n=31), hydroxychloroquine (n=11), aspirin (n=22), heparin (n=12), and azathioprine in one patient with steroid resistant nephrotic syndrome disclosing SLE. No therapeutic abortion was done. During pregnancy or the postpartum period, or both, proteinuria >0.5 g/day occurred in 10 women (five related to pre-eclampsia, four to renal flare, one to stable nephrotic syndrome). One flare consisted of mild arthralgias. Pregnancy outcome comprised one fetomaternal death in SLE disclosed by pregnancy, five embryonic losses, two fetal deaths, and 18 premature (one neonatal death) and six full term births. No criterion appeared to influence fetal survival significantly. At long term, one patient died during an SLE flare, three women had renal relapses. At the last visit, all had creatininaemia below 100 µmol/l except one woman with creatinine level 115 µmol/l, nine had proteinuria >0.5 g/day, and one was treated for hypertension. Conclusion-Pregnancy need not be discouraged in women with a history of SLE nephritis with normal or mildly impaired renal function. Deterioration of renal function rarely occurs. However, these pregnancies are at high risk of preeclampsia and prematurity. (Ann Rheum Dis 2001;60:599-604) Systemic lupus erythematosus (SLE) aVects, particularly, women of childbearing age. Global SLE survival improvement due to better therapeutic management would lead to authorisation of pregnancy in an increased number of women. However, most studies analysing the relations between SLE and pregnancy found high fetal and maternal risksnotably, when pregnancy occurs in active SLE. 1In our 1987-91 French prospective study, SLE exacerbation was seen in 60% of the pregnancies and resulted in maternal death in 1.9% of the cases. Sixty three per cent of the newborn infants were premature, 29% growth retarded, and 5% died.2 Between 1982 and 1995 we prospectively "planned" 62 pregnancies in 38 women with SLE followed up in our department. Flares occurred in 27% of the cases. No child or mother died. After exclusion of early spontaneous and induced abortions, the live birth rate was 96%, which is close to that of the general French population. 3Nephritis is known to be one of the most serious complications of SLE and a strong predictor of poor outcome. However, its influence on mortality h...

Five percent of 145 HIV-1 infected men enrolled in an assisted reproductive technology (ART) program harbored detectable HIV-1 RNA in semen, although they had no other sexually transmitted disease and their blood viral load was undetectable for at least 6 months under antiretroviral treatment. This result justifies measuring HIV-1 RNA in semen before the ART process and suggests that a residual risk of transmission has to be mentioned to the patients who would like to have unprotected sexual intercourse.