Does serologic activity (e.g., high titer dsDNA, low complements) without clinical disease activity in a pregnant lupus patient affect maternal or fetal outcomes?   

Not specifically. High titers of anti-dsDNA and low C3 and/or low C4, especially those that are adversely trending, are predictors of renal involvement which could adversely affect outcomes especially if the renal involvement mandates a change in therapy, but otherwise no. If these biomarkers are ab...

I agree with my colleague and friend, @Kenneth Kalunian's response with the following emphasis. Since C3 and C4 are acute phase reactants and typically rise beginning at the end of the second and through the third trimester of pregnancy, decreasing C3 and C4 especially if accompanied by elevations o...