A review of fetal and neonatal consequences of maternal systemic lupus erythematosus
- 1 August 2020
- journal article
- review article
- Published by Wiley in Prenatal Diagnosis
- Vol. 40 (9), 1066-1076
- https://doi.org/10.1002/pd.5709
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.Funding Information
- National Institutes of Health (R01HD079951, N01AR422, R37AR042455)
This publication has 102 references indexed in Scilit:
- Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: How should we counsel cancer patients about breastfeeding?Cancer Treatment Reviews, 2013
- Anatomical and pathological findings in hearts from fetuses and infants with cardiac manifestations of neonatal lupusRheumatology, 2012
- Evaluation of the risk of anti-SSA/Ro-SSB/La antibody-associated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposed to hydroxychloroquineAnnals Of The Rheumatic Diseases, 2010
- Evaluation of fetuses in a study of intravenous immunoglobulin as preventive therapy for congenital heart block: Results of a multicenter, prospective, open‐label clinical trialArthritis & Rheumatism, 2010
- The Unexplained Female Predominance of Systemic Lupus Erythematosus: Clues from Genetic and Cytokine StudiesClinical Reviews in Allergy & Immunology, 2010
- Recurrence rates of cardiac manifestations associated with neonatal lupus and maternal/fetal risk factorsArthritis & Rheumatism, 2009
- Prospective Evaluation of Fetuses With Autoimmune-Associated Congenital Heart Block Followed in the PR Interval and Dexamethasone Evaluation (PRIDE) StudyThe American Journal of Cardiology, 2009
- Identification of a receptor required for the anti-inflammatory activity of IVIGProceedings of the National Academy of Sciences of the United States of America, 2008
- Antibodies to amino acid 200–239 (p200) of Ro52 as serological markers for the risk of developing congenital heart blockClinical and Experimental Immunology, 2008
- Lupus Activity in PregnancyRheumatic Disease Clinics of North America, 2007