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Pregnancy Outcomes in Patients with Autoimmune Diseases and Anti-Ro/SSA Antibodies

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Abstract

Anti-Ro/SSA antibodies are associated with neonatal lupus (congenital heart block (CHB), neonatal transient skin rash, hematological and hepatic abnormalities), but do not negatively affects other gestational outcomes, and the general outcome of these pregnancies is now good, when followed by experienced multidisciplinary teams. The prevalence of CHB, defined as an atrioventricular block diagnosed in utero, at birth, or within the neonatal period (0–27 days after birth), in the offspring of an anti-Ro/SSA-positive women is 1–2%, of neonatal lupus rash around 10–20%, while laboratory abnormalities in asymptomatic babies can be detected in up to 27% of cases. The risk of recurrence of CHB is ten times higher. Most of the mothers are asymptomatic at delivery and are identified only by the birth of an affected child. Half of these asymptomatic women develop symptoms of a rheumatic disease, most commonly arthralgias and xerophtalmia, but few develop lupus nephritis. A standard therapy for CHB is still matter of investigation, although fluorinated corticosteroids have been reported to be effective for associated cardiomyopathy. Serial echocardiograms and obstetric sonograms, performed at least every 1–2 weeks starting from the 16th week of gestational age, are recommended in anti-Ro/SSA-positive pregnant women to detect early fetal abnormalities that might be a target of preventive therapy.

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Abbreviations

ANA:

Anti-nuclear antibodies

AV:

Atrioventricular

CHB:

Congenital heart block

ECG:

Electrocardiogram

NLS:

Neonatal Lupus Syndromes

SLE:

Systemic lupus erythematosus

SS:

Primary Sjögren’s syndrome

UCTD:

Undifferentiated connective tissue disease

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Authors and Affiliations

  1. Internal Medicine, Ospedali Riuniti, Largo Barozzi, Bergamo, Italy

    Antonio Brucato & Véronique Ramoni

  2. Meyer Children’s Hospital and University of Florence, Florence, Italy

    Rolando Cimaz

  3. Division of Rheumatology, University and IRCCS Policlinico San Matteo Foundation, Pavia, Italy

    Roberto Caporali & Véronique Ramoni

  4. New York University School of Medicine, New York, NY, 10016, USA

    Jill Buyon

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  3. Roberto Caporali
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  4. Véronique Ramoni
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  5. Jill Buyon
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Correspondence to Antonio Brucato.

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Brucato, A., Cimaz, R., Caporali, R. et al. Pregnancy Outcomes in Patients with Autoimmune Diseases and Anti-Ro/SSA Antibodies. Clinic Rev Allerg Immunol 40, 27–41 (2011). https://doi.org/10.1007/s12016-009-8190-6

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  • DOI: https://doi.org/10.1007/s12016-009-8190-6

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