Physician approval for pregnancy in patients with SLE showing only serological activity: A vignette survey study

Background: The EULAR recommendation requires that the disease activity of systemic lupus erythematosus before pregnancy be stable because pregnancy complications and disease flares increase if pregnancy occurs while systemic lupus erythematosus activity is high. However, some patients have ongoing serological activity even after treatment. Herein, we aimed to investigate how physicians make decisions on the acceptability of pregnancy when patients with systemic lupus erythematosus only have serological activity. Methods: : A questionnaire was administered online to physicians from December 2020 to January 2021. It included the characteristics of physicians, facilities, and the allowance for pregnancies for patients with systemic lupus erythematosus using vignette scenarios. Results: : The questionnaire was distributed to 4,946 physicians, and 9.4% of physicians responded. The median age of respondents was 46 (range: 38–54) years, and 85% were rheumatologists. Pregnancy allowance was significantly affected by duration of the stable period, and mild or high serological activity, respectively (duration: proportion difference, 11.8 percentage points [p.p.]; p < 0.001; mild: proportion difference, -25.8 p.p; p < 0.001; high: -65.6 p.p.; p < 0.001). Even though patients had a high level of serological activity, 20.5% of physicians allowed pregnancy if there were no clinical symptoms for six months. Conclusions: : Serological activity had a significant effect on physician judgment on the acceptability of pregnancy. Conversely, some physicians allowed patients who only had serological activity to become pregnant. Further observational studies are required to clarify the prognosis of such patients.