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Impact of in utero environment on the offspring of lupus patients

Spedali Civili and University of Brescia, Brescia, Italy; Reumatologia e Immunologia Clinica, Ospedale Civile di Brescia, 25125 Brescia, Italy tincani{at}bresciareumatologia.it

E Danieli

M Nuzzo

M Scarsi

M Motta

Spedali Civili and University of Brescia, Brescia, Italy

R Cimaz

University of Lyon, France

A Lojacono

R Nacinovich

F Taddei

Spedali Civili and University of Brescia, Brescia, Italy

A Doria

University Hospital-Padua, Padova, Italy

A Brucato

Ospedale Niguarda, Milan, Italy

P Meroni

IRCCS Ist. Auxologico University of Milan, Milan, Italy

for the Pregnancy Study Group of Italian Society of Rheumatology

The number of patients affected by systemic lupus erythematosus (SLE) that decide to have children has greatly increased probably because of recent improvements in the diagnosis and management of the disease. This has stimulated our interest in defining the outcome of children, focusing both on neonatal problems and long term development. SLE patients still carry a risk of pregnancy loss. However, due to careful monitoring and treatment by a multidisciplinary team, the number of losses has dramatically decreased, but an increased number of preterm deliveries is still a problem. Neonatal lupus is linked to the presence of anti-Ro/SS-A and anti-La/SS-B antibodies in the mother, although other factors probably of fetal origin are important. Neonatal lupus is a complex condition whose most serious manifestation is the congenital heart block (CHB). Usually, children with complete CHB need permanent pacing, but apparently do not have neuropsychological problems. Studies focusing on the neuropsychological development of SLE offspring show an increased number of learning disabilities in children with normal intelligence levels. Fetal consequence of maternal treatment need to be considered choosing non teratogenic drugs, but the withdrawal of medications just because the patient is pregnant should be avoided to avoid SLE flares.

Key Words: antiphospholipidantibodies • immunosuppressivedrugs • learningdisabilities • neonatallupus • SLEpregnancy

Lupus, Vol. 15, No. 11, 801-807 (2006)
DOI: 10.1177/0961203306071005


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