question: Hello doctor,My daughter had a little girl four years ago. About three months postpartum, she fell down a flight of stairs injuring her back. At the same time, she had a very bad cold. When her back continued to give her pain after seeing the orthopedist, she went to a neurologist. Her blood work showed an ANA of 640 and a positive anti-DNA number. She was told that she was a candidate for developing lupus. Since that time she had seen a series of rheumatologist as her ANA has remained positive, rarely 320 but generally 180. He just went for a routine rheumatology and her ANA is negative as is her anti-DNA number. Of course, she is elated, as she and her husband have wanted a second child badly. They have been afraid however because of the risk of her developing lupus, especially afraid of becoming disabled as she already has one small child who needs her care. She has also been told that the offspring of women with positive ANA with potential lupus may have children with a higher incidence of autism, another great fear in this generation.She is now very confused about how to proceed in terms of getting pregnant. On one hand, it feels like she may have dodged a bullet - and if so is there any sense in running after the bullet? On the other hand, she is trying to think positively that this may be a window during which a pregnancy might be safe. There seems to be a rise in autoimmune disorders in general, especially among childbearing age women. She is a 35 year old professional. Of course, pregnancy is a hormonal firestorm and she is afraid that it will reignite lupus. On the other hand, she and her husband desperately want a second child. In your experience, once an individual who had previously tested positive ANA for four years goes to a negative status, is it likely they will remain there? Would you advise against the pregnancy? In your practice have you seen the offspring of ANA positive having a greater incidence of neuro-developmental disabilities like autism? (she was never positive for that congenital lupus marker). Do you think it is likely that the pregnancy would put her at greater risk for developing lupus either now or in the future?