Pregnancy and Assisted Reproductive Outcomes in Women with Systemic Lupus Erythematosus, Sjögren Syndrome and Antiphospholipid Syndrome: An Umbrella Review

Objective: Systemic lupus erythematosus (SLE), Sjögren syndrome (SS) and antiphospholipid syndrome (APS) are common autoimmune conditions in child-bearing aged women, but their influence on pregnancy and assisted reproductive outcomes remain controversial. We aimed to perform an umbrella review to summarize the current evidence to provide a reference for clinicians and future research. Methods: PubMed, Embase (Ovid) and Cochrane database were searched (inception to April 2025) for relevant publications. Study selection, data extraction, quality evaluation, evidence grading and data synthesis were completed independently by two authors. Odds ratio, relative risk or standardized mean difference with 95% confidence intervals were calculated. Results: Fourteen articles (51 meta-analyses) were included, to report the associations of SLE, primary SS (pSS), antiphospholipud antibodies (aPLs), primary APS (pAPS) and 6 maternal/8 fetal/5 assisted reproductive outcomes. SLE and pAPS significantly increased the risks of spontaneous abortion, total fetal loss, pregnancy-induced hypertension, premature delivery, small for gestational age, neonatal death and neonatal intensive care unit. SLE also decreased anti-Müllerian hormone level and significantly increased the risks of pre-eclampsia (PE), stillbirth, low birth weight (LBW) and neonatal one minute Apgar < 7. pSS significantly increased spontaneous abortion and LBW risks. Positive aPLs significantly increased the risk of miscarriage rate in assisted reproductive techenology (ART) and were also associated with total fetal loss, PE, intrauterine growth retardation and placental abruption. Conclusions: This review offers a thorough overview of the current evidence linking SLE, SS and APS to pregnancy and assisted reproductive outcomes. It identifies existing gaps and proposes future research directions.