Abstract
Pregnancy raises the risk of maternal and fetal complications in systemic lupus erythematosus (SLE) patients due to physiological and immunological changes, with infections standing out as a significant concern. It is important to conduct a comprehensive examination of the structure and trends in the scientific literature of this field. This bibliometric study analyzed publications on SLE-related infections during pregnancy using the Scopus database. The search was conducted on January 15, 2026, using the keywords “Systemic Lupus Erythematosus”, “Pregnancy”, and “Infection” in the title, abstract, and keyword fields. The analysis included an examination of publication distribution and trends over time using linear regression. Data on countries, authors, institutions, funding sources, journals, document types, and keywords of the articles were collected. A total of 994 publications were included in the analysis. The annual number of publications increased significantly over the years and the publication output peaked in 2024 (n = 73) (R² = 0.664, p < 0.001). In total, 71 countries contributed to the literature, with 28 classified as main active countries (≥ 1% of total output). The majority of document types were articles (n = 528) and reviews (n = 354). In terms of publication volume, the United States (n = 299), the United Kingdom (n = 101), and Italy (n = 83) were prominent, whereas in terms of citations per paper, Hungary (170.4), Greece (137.23), and the Netherlands (116.55) exhibited the highest impact. The most productive journals included Lupus (n = 36), Frontiers in Immunology (n = 20), and Annals of the Rheumatic Diseases (n = 14). This analysis reveals a significant upward trend in the scientific literature in recent years and the increasing clinical importance of the subject.
Keywords: Systemic lupus erythematosus, Pregnancy, Infections, Bibliometrics, Bibliometric analyses, Pregnancy complications, Databases, Bibliographic
Introduction
Systemic lupus erythematosus (SLE) is a diverse, complex, and multisystemic autoimmune disorder predominantly impacting women of reproductive age [1]. SLE impacts the pregnancy period, increasing the risk of maternal and fetal complications [2]. Patients with SLE exhibit an elevated susceptibility to infections compared with the general population, attributable to compromised immune function, organ involvement, and regular use of immunosuppressive therapies [3]. The heightened risk of infection is particularly evident during pregnancy, a phase characterized by substantial physiological and immunological alterations. The immune adaptation mechanisms that emerge during pregnancy, along with the complex characteristics of SLE, may substantially increase the risk of infections during pregnancy [4, 5].
Bibliometric analysis is an approach that aims to assess the framework, developmental course, and research trends within a particular scientific domain using quantitative data [6, 7]. Analyzing publication statistics, citation metrics, contributions by countries, institutions, and authors, and keyword distributions facilitates understanding of scientific output, impact levels, and research trends within a topic [8, 9]. This approach promotes systematic mapping of the knowledge in the literature, identification of prominent research institutions and collaborations, and forecasting of prospective research domains. In recent years, bibliometric investigations, particularly in medicine and the health sciences, have been widely used to assess research dynamics [10, 11].
This study aimed to conduct a thorough bibliometric analysis of the scientific literature on SLE-related infections during pregnancy. The analysis encompassed the annual distribution of publications, temporal trends, contributions by countries, institutions, and authors, the most prolific journals, funding sources, and keyword patterns. The objective was to ensure that the findings enhance comprehension of research trends within this domain and provide directions for subsequent studies.
Materials and methods
Search strategy
This study utilized the Scopus database to examine scientific publications on infections during pregnancy in SLE. Publication data were acquired from a search conducted on January 15, 2026. The search strategy was established employing the keywords “Systemic Lupus Erythematosus” AND “Pregnancy” AND “Infection,” which were queried in the title, abstract, and/or keyword fields (TITLE–ABSTRACT–KEYWORDS). No time frame constrained the study; therefore, all studies published from the earliest date in 1964 through to 2026 were incorporated into the analysis. Furthermore, all publication types indexed by the Scopus database, including articles, reviews, conference papers, and other document types, were assessed [12, 13]. This search approach was implemented to ensure a thorough representation of the literature on the topic, minimize the risk of omitting relevant publications, and comprehensively assess the historical development. No language restrictions were set, thereby guaranteeing the incorporation of works published in different languages in the analysis. This approach sought to offer a more comprehensive perspective on the subject and to assess publications on the topic thoroughly.
Data collection
All publications retrieved from the Scopus database in accordance with the specified search criteria were recorded for analysis. Within the scope of the investigation, the annual distribution of publications from 1964 to 2026 was documented. By assessing the distribution of publications across countries, the total number of contributing countries was determined. Countries that accounted for 1% or more of total publications were designated as “main active countries” [14, 15]. For these countries, total number of publications, total number of citations, and average citations per paper (citations per publication) were calculated and recorded. The ten leading journals in this field were identified. Total citations and average citations per publication for each journal were noted. The CiteScore 2024 data for the ten leading journals was obtained from the Scopus database. CiteScore is a metric that quantifies the average citations received by papers published in a journal [16]. Distribution of publications by document type was examined, and number of publications for each category was documented. The ten most prolific institutions contributing to the literature were picked. The ten most frequently used keywords were identified and listed by frequency. The five most prolific authors in literature were identified, and their publication counts were documented.
Statistical analyses
Data are expressed as numbers (n). Graphs and other visual representations were generated using Microsoft Excel. The trend in the number of publications over the years was analyzed using linear regression in the Statistical Package for the Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA). A p-value less than 0.05 was considered statistically significant.
Results
In accordance with the search strategy outlined in the Methods section, a total of 994 documents were incorporated into the bibliometric analysis. The initial publication in the field was released in 1964, and data from 1964 to 2026 were examined to assess publication trends over time. When analyzing the distribution of annual publication counts over time, it was observed that publication output peaked in 2024 (n = 73). Linear regression analysis (trend analysis) conducted to assess the change in the annual number of publications from 1964 to 2026 demonstrated that the model was statistically significant (R² = 0.664, p < 0.001), with the year variable showing a positive association with publication output (B = 0.80, 95% CI 0.66–0.94). Analysis of the regression coefficients indicated that the year variable exerted a positive, statistically significant effect on the number of publications (B = 0.80, t = 10.98, p < 0.001). These findings demonstrate that the number of publications increased by approximately 0.8 units per year throughout the study period, revealing a statistically significant upward trend in this field (Fig. 1).
Fig. 1.
Distribution of the number of publications over the years
When the distribution of publications by countries was assessed, 71 countries were identified as contributing to the literature. Countries providing 1% or more of the total publications were assigned as “main active countries”, with 28 countries identified within this category (Table 1) (Fig. 2). Based on the number of papers, the leading three countries were the United States (n = 299), the United Kingdom (n = 101), and Italy (n = 83). When assessed by citations per publication, the top three were Hungary (170.4), Greece (137.23), and the Netherlands (116.55).
Table 1.
Publication output and citation impact of the main active countries
| Country | Number of Publications | Total Citations | Citations per Publication |
|---|---|---|---|
| United States | 299 | 19,338 | 64.68 |
| United Kingdom | 101 | 8569 | 84.84 |
| Italy | 83 | 6295 | 75.84 |
| France | 78 | 5549 | 71.14 |
| China | 67 | 1475 | 22.01 |
| Canada | 59 | 3094 | 52.44 |
| India | 50 | 904 | 18.08 |
| Spain | 45 | 2400 | 53.33 |
| Germany | 45 | 3389 | 75.31 |
| Netherlands | 40 | 4662 | 116.55 |
| Japan | 38 | 555 | 14.61 |
| Brazil | 35 | 1086 | 31.03 |
| Australia | 31 | 762 | 24.58 |
| Israel | 30 | 2918 | 97.27 |
| Sweden | 28 | 1914 | 68.36 |
| Switzerland | 21 | 1079 | 51.38 |
| Austria | 18 | 1767 | 98.17 |
| Belgium | 16 | 1698 | 106.13 |
| South Africa | 15 | 145 | 9.67 |
| Poland | 15 | 371 | 24.73 |
| Mexico | 13 | 432 | 33.23 |
| Greece | 13 | 1784 | 137.23 |
| Norway | 12 | 415 | 34.58 |
| Argentina | 12 | 578 | 48.17 |
| United Arab Emirates | 11 | 231 | 21.00 |
| Taiwan | 11 | 92 | 8.36 |
| Hungary | 10 | 1704 | 170.40 |
| Ireland | 10 | 912 | 91.20 |
Countries that contributed ≥ 1% of total publications were classified as main active countries. Citation impact is expressed as average citations per publication
Fig. 2.
Geographical distribution of main active countries by number of publications
The top ten journals producing the most publications in this field are the following: Lupus (n = 36), Frontiers in Immunology (n = 20), Annals of the Rheumatic Diseases (n = 14), Autoimmunity Reviews (n = 12), Seminars in Arthritis and Rheumatism (n = 10), Journal of Rheumatology (n = 10), American Journal of Obstetrics and Gynecology (n = 9), Medicine (United States) (n = 8), Clinical Rheumatology (n = 8), and Blood (n = 8) (Table 2). Based on citations per publication, the top three journals are Annals of the Rheumatic Diseases (222.21), Blood (173.5), and American Journal of Obstetrics and Gynecology (155.22). According to CiteScore 2024 rankings, the top three journals are Annals of the Rheumatic Diseases (33.2), Blood (23), and Autoimmunity Reviews (16.8).
Table 2.
Top ten sources by number of publications
| Source | Number of Publications | Citations per Publication | CiteScore 2024 |
|---|---|---|---|
| Lupus | 36 | 26.25 | 4.1 |
| Frontiers in Immunology | 20 | 50.75 | 10.8 |
| Annals of the Rheumatic Diseases | 14 | 222.21 | 33.2 |
| Autoimmunity Reviews | 12 | 52.25 | 16.8 |
| Seminars in Arthritis and Rheumatism | 10 | 83 | 8.1 |
| Journal of Rheumatology | 10 | 32.1 | 5.9 |
| American Journal of Obstetrics and Gynecology | 9 | 155.22 | 14.2 |
| Medicine (United States) | 8 | 22 | 2.5 |
| Clinical Rheumatology | 8 | 7.38 | 5.9 |
| Blood | 8 | 173.5 | 23 |
Journals are ranked by publication volume. Citation impact is presented as average citations per publication, and CiteScore 2024 values are provided to reflect journal-level scientific influence
Analysis by document type revealed that articles (n = 528) constituted the vast majority of publications, followed by reviews (n = 354). Conference papers (n = 30), book chapters (n = 26), letters (n = 19), editorials (n = 15), short surveys (n = 11), and notes (n = 11) had a limited share in the literature (Fig. 3).
Fig. 3.
Distribution of publication numbers according to document type
Among the most prolific authors, Shoenfeld, Y. (n = 13) ranked first, followed by Tincani, (A) (n = 10). Cervera, R. (n = 8), Godeau, P. (n = 8), and Wechsler, (B) (n = 8) were identified as other leading prolific authors in this field (Table 3).
Table 3.
Five most prolific authors and number of publications
| Author | Number of Publications |
|---|---|
| Shoenfeld, Y. | 13 |
| Tincani, A. | 10 |
| Cervera, R. | 8 |
| Godeau, P. | 8 |
| Wechsler, B. | 8 |
Keyword analysis revealed that the ten most frequently used keywords were Human (n = 937), Systemic Lupus Erythematosus (n = 880), Pregnancy (n = 761), Female (n = 643), Humans (n = 609), Article (n = 476), Adult (n = 410), Review (n = 371), Priority Journal (n = 331), and Infection (n = 280) (Table 4).
Table 4.
Top ten keywords by number of occurrences
| Keyword | Number of Occurrences |
|---|---|
| Human | 937 |
| Systemic Lupus Erythematosus | 880 |
| Pregnancy | 761 |
| Female | 643 |
| Humans | 609 |
| Article | 476 |
| Adult | 410 |
| Review | 371 |
| Priority Journal | 331 |
| Infection | 280 |
When the distribution of publications by institution was examined, the University of Toronto (n = 22) stood out as the institution with the most publications, followed by Università degli Studi di Milano (n = 19) and Harvard Medical School (n = 18). Other leading institutions included Hôpital Universitaire Pitié Salpêtrière (n = 17), University College London (n = 17), Hospital for Special Surgery – New York (n = 17), Inserm (n = 16), Tel Aviv University (n = 16), Weill Cornell Medicine (n = 15), and Hospital Clínic de Barcelona (n = 15) (Table 5).
Table 5.
Top ten institutions by number of publications
| Institution | Number of Publications | Country | |
|---|---|---|---|
| University of Toronto | 22 | Canada | |
| Università degli Studi di Milano | 19 | Italy | |
| Harvard Medical School | 18 | United States | |
| Hôpital Universitaire Pitié Salpêtrière | 17 | France | |
| University College London | 17 | United Kingdom | |
| Hospital for Special Surgery – New York | 17 | United States | |
| Inserm | 16 | France | |
| Tel Aviv University | 16 | Israel | |
| Weill Cornell Medicine | 15 | United States | |
| Hospital Clínic de Barcelona | 15 | Spain |
When funding sources were examined, the National Institutes of Health (NIH, United States; n = 25) stood out as the organization supporting the most publications. This was followed by the National Natural Science Foundation of China (NSFC, China; n = 19) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS, United States; n = 18). Other prominent funders included the Japan Society for the Promotion of Science (JSPS, Japan; n = 11) and the Medical Research Council (MRC, United Kingdom; n = 9) (Table 6).
Table 6.
Top five funding sources
| Funding Sources | Country | Number of Supported Publications |
|---|---|---|
| National Institutes of Health (NIH) | United States | 25 |
| National Natural Science Foundation of China (NSFC) | China | 19 |
| National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) | United States | 18 |
| Japan Society for the Promotion of Science (JSPS) | Japan | 11 |
| Medical Research Council (MRC) | United Kingdom | 9 |
Discussion
This bibliometric analysis revealed a significant upward trend in the scientific literature on SLE-related infections during pregnancy, underscoring the expanding clinical and scientific importance of this field. While the United States, the United Kingdom, and Italy led in total number of papers, Hungary, Greece, and the Netherlands showed high levels of scientific impact citation-wise. Furthermore, analyses of journals, institutions, authors, and funding sources revealed that research in this field is centered on particular centers and collaborative efforts, while the distribution of keywords confirmed that themes related to pregnancy, infection, and women’s health predominate in the literature.
Recent clinical data underscore the importance of improved pregnancy care in SLE. A nationwide Finnish case-control study indicated generally moderate pregnancy outcomes, although it revealed elevated rates of urgent cesarean deliveries and neonatal critical care unit admissions among women with SLE compared to controls [17]. Moreover, evidence from specialized pregnancy and rheumatic disease clinics suggests that organized pre-pregnancy planning may mitigate disease flares and medication changes during pregnancy [18], likely contributing to the increasing research interest identified in this bibliometric analysis.
The rising trend in publication volume reflects the growing clinical and scientific relevance of SLE-related infections during pregnancy. The notable rise in publication output, particularly in recent years, may be attributed to the heightened emphasis on pregnancy counseling and the necessity for a deeper comprehension of the infection risks faced by this patient group [19, 20]. Furthermore, the increased use of immunosuppressive and biologic agents in SLE treatment may have contributed to the infection risk during pregnancy, becoming a more complex clinical issue [21, 22]. This situation may have heightened the need for evidence-based strategies to prevent, diagnose, and manage infections, possibly encouraging research in this area.
The extensive geographical dispersion of papers, with contributions from 71 countries, underscores the global relevance of SLE-related infections during pregnancy. However, the identification of 28 main active countries reveals that scientific activity is concentrated in certain regions. The prominence of the United States, the United Kingdom, and Italy in publication output certainly indicates robust research systems, specialized referral institutions, and sustained funding [23]. Hungary, Greece, and the Netherlands exhibited the most citations per paper. The elevated citation rates in such countries may be ascribed to an emphasis on hypothesis-centered investigations, pivotal clinical trials, or research that feeds guidelines and significantly impacts future studies.
High number of papers in Lupus, Frontiers in Immunology, and Annals of the Rheumatic Diseases suggests that this issue is predominantly addressed within the fields of rheumatology and immunology. The fact that Annals of the Rheumatic Diseases, Blood, and the American Journal of Obstetrics and Gynecology rank high in the evaluation of citations per publication suggests that studies in these journals have substantial scientific influence on the literature. The inclusion of Blood and the American Journal of Obstetrics and Gynecology, in particular, suggests that infections related to SLE during pregnancy are not restricted to the field of rheumatology.
Keyword analysis indicates that the literature was predominantly organized around clinical research on human subjects, female characteristics, and pregnancy. The high frequency of the terms “Systemic Lupus Erythematosus”, “Pregnancy”, and “Infection” indicates that the study’s topic was clearly and consistently handled in the literature.
The institutional distribution shows that publications on SLE-related infections in pregnancy were concentrated in institutions with strong academic infrastructure and multidisciplinary approaches. The prominence of institutions such as the University of Toronto, Università degli Studi di Milano, and Harvard Medical School suggests that these centers have strong research traditions in rheumatology, obstetrics, and immunology.
An analysis of funding sources suggests that most research is conducted with significant public support at the national level. The prominence of funding institutions, notably those in the United States (NIH and NIAMS), reflects the presence of long-term research plans in this subject [24, 25]. Contributions from national research funds in China, Japan, and the United Kingdom suggest that this topic has emerged as a global research priority.
Limitations
The study has several limitations. First, the analysis was restricted to the Scopus database. Therefore, certain papers indexed by other reputable databases may have been excluded from the research. However, given the broad scope of the Scopus database, the current data correctly reflect research trends in the field [26]. Second, bibliometric analyses rely on quantitative indicators, and the scientific quality, methodological soundness, and clinical influence of papers are not examined. Citation counts and bibliometric indicators reflect the influence of publications, but they are dynamic metrics that vary over time. Although no language restrictions were set in the study, publications in languages other than English received fewer citations, which may have influenced the interpretation of specific results. Finally, this study has a cross-sectional design, with analyses based on data obtained on a particular date. As a result, future publications or changes in citation numbers over time are not captured in the current analysis.
From an organizational standpoint, this bibliometric analysis may inform the design of rheumatological and obstetric care for pregnant women with SLE, underscoring the importance of managing infection risk during pregnancy. The presence of numerous high-impact studies in multidisciplinary centers underscores the need for coordinated care approaches that integrate expertise in rheumatology, obstetrics, and infectology, along with structured pre-pregnancy counseling, to improve outcomes.
Conclusion
This bibliometric analysis demonstrated an upward trend in the scientific literature on SLE-related infections in pregnancy over time, reflecting the issue’s growing clinical and scientific significance. The outcomes indicated that research output is predominantly concentrated in certain countries and institutions. Analysis of journals, authors, institutions, and funding sources revealed that SLE-related infections during pregnancy have emerged as a multidisciplinary research domain encompassing rheumatology, immunology, and obstetrics. It is anticipated that the findings will inform future clinical and epidemiological investigations, support the identification of research gaps, and facilitate the development of strategies for more effective management of infection risk within this patient group.
Author contributions
Study design: DY, MM, OZ, MK, BFK. Data acquisition and review of the literature: DY, OZ, BFK. Making interpretations: DY, MM, OZ, MK, BFK. Drafting the manuscript: DY and BFK. Critically reviewing the manuscript: DY, MM, OZ, MK, BFK.
Funding
Open access funding provided by the Scientific and Technological Research Council of Türkiye (TÜBİTAK). An application will be made to the Scientific and Technological Research Council of Türkiye (TÜBİTAK) for open-access publishing.
Data availability
Raw data can be provided by the corresponding author upon reasonable request.
Declarations
Conflict of interest
The authors declare no conflicts of interest.
Responsibility for the integrity and accuracy
All authors take full responsibility for the integrity and accuracy of all aspects of the work.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Raw data can be provided by the corresponding author upon reasonable request.