**9.2 Newborn complications of SLE**

In general, SLE in pregnancy is associated with a higher incidence of stillbirths, a greater occurrence of great premature babies, with a greater number of newborns admitted to neonatal intensive care units, an APGAR score below 7 within 1 and 5 minutes and a significantly higher number of birth defects [33, 77, 78].

Neonatal SLE (0 to 27 days after delivery) is an autoimmune disease that results from passive transfer of autoantibodies from a mother with SLE to the fetus, resulting in fetal and neo-natal disease. It occurs in about 3.5–8% of theses pregnancies and is associated with the presence of maternal anti-Ro/SSA and anti-La/SSB autoantibodies [20, 79]. Main manifestations involve cutaneous and cardiac systems, but it can affect and cause other organ dysfunctions (including thrombocytopenia, hepatitis, and myocarditis) [71]. The presence of anti-Ro/SSA antibodies may be associated with clinical manifestations, but does not appear to have a negative impact on other SLE-related events during pregnancy [80].

The most frequent manifestation of SLE in the neonate, with a prevalence of 10 to 20%, is a transient cutaneous rash with annular or elliptical erythematous plaques, which develops in the weeks following delivery [80]. It involves predominantly the face and scalp, is generally photosensitive and resolves spontaneously in the first 6 to 8 months of life, which coincides with the clearance of maternal autoantibodies from the circulation [71].

The most serious complication of neonatal SLE is a CHB, which can be diagnosed in-utero, on the date of birth or in the neonatal period. This occurs in about 2% of the fetuses of women with anti-Ro/SSA antibodies with a recurrence rate of 20% in the following pregnancies [76, 81, 82]. CHB can be of any degree and can be accompanied by extra-nodal disease, with valve involvement, endocardial (endocardial fibroelastosis) or structural changes, including dilated cardiomyopathy. About 60% of CHB babies will require a pacemaker; 10% of those will develop cardiomyopathy after birth [12]. The 10-year mortality rate ranges 20–35%. The use of HCQ during pregnancy seems to reduce in 65% the risk of cardiac manifestations of neonatal lupus in women with anti-Ro/SSA and anti-La/SSB autoantibodies [83, 84]. Despite immunoglobulin can reduce transplacental transfer of anti-Ro/SSA antibodies, a clinical trial failed to prove its efficacy [22].

Management of SLE pregnancy includes serial fetal echocardiography surveillance between 16 and 28 weeks of gestation [22]. If CHB is detected, it is usually no longer reversible. However, corticosteroids that are transplacental, as dexamethasone, can be administrated in order to reduce the resultant cardiomyopathy.

**101**

**Author details**

under control.

Melissa Fernandes1

Ana Lladó1,2 and Fátima Serrano2,3

Universitário Lisboa Central, Lisbon, Portugal

Universitário Lisboa Central, Lisbon, Portugal

provided the original work is properly cited.

\*, Vera Bernardino1,2, Anna Taulaigo1

outcome for both mother and child has become a more frequent reality.

In this way, even if SLE keeps being a severe risk factor for pregnancy, a healthy

Prognostic factors related to poor outcomes of neonatal CHB include: detection of CHB at gestational age < 20 weeks, ventricular rate < 50 bpm, fetal hydrops, carditis, changes in fetal echocardiogram, endocardial fibroelastosis, impaired left ventricular function, and a maternal diagnosis of SLE or Sjögren's syndrome [12].

The improvement in disease management and pregnancy monitoring have resulted in a significant decrease in maternal and fetal complications in the last few decades. This has been mainly contributed by 3 pillars: 1) new technologies – which have permitted a better understanding of the immunopathogenesis of the disease, enabling substantial data on SLE patients and focusing on the area of genetics, such as genetic predisposition, epigenetics contribution and how these contribute in developing irreversible loss of immunologic self-tolerance; 2) access to healthcare – has permitted SLE patients to better hospital care through the course of their disease; and most importantly: 3) multidisciplinary management – this is essential to achieve successful maternal and fetal outcomes. This is made by a multidisciplinary team of experienced and dedicated physicians that define a strategic plan, such as preconception counseling, pregnancy planning and increased availability of safe drugs in pregnancy and puerperium, to improve both maternal and fetal outcomes. It is crucial to make the correct choice of therapy for women with SLE preconceptionally, during pregnancy and lactation. Medications must be reviewed and adjusted to minimize the effect on the fetus, while maintaining the disease

1 Internal Medicine Department, Hospital Curry Cabral, Centro Hospitalar

3 Obstetric Department, Maternidade Alfredo da Costa, Centro Hospitalar

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

2 Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal

\*Address all correspondence to: melissa.a.fernandes@gmail.com

, Jorge Fernandes1

,

*Systemic Lupus Erythematosus Pregnancy DOI: http://dx.doi.org/10.5772/intechopen.99008*

**10. Conclusion**

Prognostic factors related to poor outcomes of neonatal CHB include: detection of CHB at gestational age < 20 weeks, ventricular rate < 50 bpm, fetal hydrops, carditis, changes in fetal echocardiogram, endocardial fibroelastosis, impaired left ventricular function, and a maternal diagnosis of SLE or Sjögren's syndrome [12].
