A review of fetal and neonatal consequences of maternal systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and is commonly seen in pregnancy. The physiologic and immunologic changes of pregnancy may alter the course of SLE and impact maternal, fetal, and neonatal health. Multidisciplinary counseling before and during pregnancy from rheumatology, maternal fetal medicine, obstetrics, and pediatric cardiology is critical. Transplacental passage of autoantibodies, present in about 40% of women with SLE, can result in neonatal lupus (NL). NL can consist of usually permanent cardiac manifestations, including conduction system and myocardial disease, as well as transient cutaneous, hematologic, and hepatic manifestations. Additionally, women with SLE are more likely to develop adverse pregnancy outcomes such as preeclampsia, fetal growth restriction, and preterm birth, perhaps due to an underlying effect on placentation. This review describes the impact of SLE on maternal and fetal health by trimester, beginning with prepregnancy optimization of maternal health. This is followed by a discussion of NL and the current understanding of the epidemiology and pathophysiology of anti‐Ro/La mediated cardiac disease, as well as screening, treatment, and methods for prevention. Finally discussed is the known increase in preeclampsia and fetal growth issues in women with SLE that can lead to iatrogenic preterm delivery.

Inflammatory factors, genetic variants, and predisposition for preterm birth

“…Pregnant women with SLE have a PTB risk above the worldwide average prevalence (16%–50%) 101 . According to the literature, one‐third of all SLE pregnancies are delivered preterm 102 .…”

Outcomes of pregnancy and associated factors in sub-Saharan African women with systemic lupus erythematosus: a scoping review

“…14 32 The increased rate of low birth weight may also be due to the high prevalence of pre-eclampsia which is one of its major risk factors. 14 Taken collectively, our results suggest that advances in SLE management over the last decades 6 33 34 may not have greatly influenced the overall outcome of SLE pregnancies in sub-Saharan Africa, as lower proportions of APOs were expected based on contemporary data from other parts of the world. 2 4 10 11 31 To reach optimum rates of successful pregnancies 4 10 11 in sub-Saharan Africa, strengthening of preconception counselling, risk stratification and monitoring of pregnancies are therefore paramount.…”

Coronary Involvement in Cardiac Neonatal Lupus

“…Reported cardiac involvement in neonatal lupus, secondary to passive transplacental transfer of maternal autoantibodies to the SSA/Ro ribonucleoprotein complex, appears to be limited to fetal atrioventricular block and myocardial disease. 4 We described coronary involvement in our patient. This coronary involvement responded successfully to IVIg infusion and corticosteroid treatment.…”