Background Pregnant women with autoimmune disease (AID), particularly systemic lupus erythematosus (SLE), have increased risks of disease exacerbation, pre/eclampsia and other maternal and fetal complications. Low birth weight (LBW) for gestational age, preterm delivery and neonatal lupus (NL), which occurs in 1.5% of newborns of mothers with SLE, are some of the associated fetal complications.
Objectives To report the maternal and fetal morbidities associated with deliveries by women with AID at a regional hospital.
Methods Retrospective data were collected between 2003 and 2010 at a regional hospital. The reference area included 300,000 inhabitants. We analyzed the clinical and laboratory characteristics of mothers with AID and the complications experienced by their newborns. We recorded the maternal and neonatal disorders arising from this disease.
Results Over this 7-year period, 29 mothers were analyzed. There were 52 pregnancies, which resulted in 39 newborns. There were 13 miscarriage (45%), all of them in mothers with antiphospholipid syndrome (APS).
The AIDs of the mothers were 19 SLE (67%), 3 cutaneous lupus, 3 primary Sjögren’s syndrome, 2 mixed connective tissue disease, 1 primary APS and 1 systemic sclerosis. There were 8 instances of maternal complications (26%) during the pregnancies including 1 digital vasculitis, 1 pancreatitis, 1 outbreak of glomerulonephritis, 1 gestational diabetes, 3 preeclampsia and 1 eclampsia. One patient experienced significant improvement of her arthritis. During the postpartum period, there was 1 case of lupus fever and 1 case of eclampsia, pneumonitis and respiratory failure with a favorable outcome.
Among the newborns, 7 were preterm (21%), 8 had LBW (35%) and 4 exhibited the transplacental passage of maternal antibodies (1anti-Sm , 1 anti-Ro, 1 anti-Ro plus anti-La and 1 anti-Ro plus anti-RNP). One newborn developed transient cutaneous NL with the transplacental passage of maternal anti-Sm antibodies .
Electrocardiography (ECG) was performed on 50% of the babies, and no abnormal results were observed. One of the daughters born to a mother with SLE was diagnosed with ANA negative self-limited oligoarthritis at 12 months of age. A son born to a mother with primary APS exhibited idiopathic thrombocytopenic purpura.
Conclusions In our hospital, the rates of miscarriage, prematurity and LBW among the newborns of mothers with AID are similar to those reported in the literature. The observation of a case of NL with the transplacental passage of anti-Sm*, not previously reported in the literature, is remarkable.
Ortiz-Santamaria V, Olive A, Martinez-Cáceres E, Coll MT, Codina X, Surís X. Lupus 2010; 19: 659-61.
Disclosure of Interest None Declared
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