What is Neonatal Lupus?
Women who suffer with active lupus have a higher risk of having complications with pregnancy. These complications include preeclampsia, miscarriage and preterm delivery. One of the other rare complications that can occur is neonatal lupus. Neonatal lupus is an autoimmune disorder that is estimated to occur in around 1 in 15,000 live births. It is believed to happen when certain antibodies are passed from a pregnant woman to the placenta at around 12-14 weeks gestation. These antibodies (anti-Ro/SSA and anti-La/SSB) are produced by people who have autoimmune diseases such as lupus, Sjogren’s syndrome and rheumatoid arthritis. After birth, the infant usually has a distinguishable red skin rash which can present itself within the first one to two months of life. The most serious complication involved with neonatal lupus is the heart condition known as congenital heart block. Below we will delve into the signs, symptoms and treatments for not only this condition, but other aspects to this rare disorder as well. Back to top
Antibodies: Neonatal lupus is thought to be the result of the passage of antibodies to the placenta. These antibodies (in most cases, the anti-Ro/SSA antibody or anti-La/SSB antibody) can be dangerous to the growing fetus because the placenta cannot distinguish between the good antibodies and the bad autoantibodies (antibodies that damage tissue). In neonatal lupus, most often the heart tissue, blood, skin and liver are affected by these autoantibodies mistakenly damaging healthy fetal tissue. If a woman tests positive for the anti-Ro or anti-La antibodies, she will pass on the antibodies to the fetus. However only one in 50 fetuses will develop neonatal lupus. Why you ask? Researchers don’t know the exact reason, but believe that other genetic or environmental factors come into play. APL antibodies are another type of antibody that are responsible for phospholipid antibody syndrome (or lupus anticoagulant syndrome) which can increase a woman’s risk of miscarriage, involve slow fetal growth and increase risk of preeclampsia, but is not necessarily related to neonatal lupus or it’s symptoms. Every woman who has lupus, RA, Sjogren’s or any other autoimmune disorder should be advised to be tested for anti-Ro, anti-La and aPL antibodies as part of her pre-pregnancy counseling.
Congenital Heart Block: Probably the most serious problem associated with neonatal lupus is a condition called congenital heart block. It is a potentially life-threatening condition where autoantibodies damage the normal electrical signal that stimulates the heartbeat. This results in an unusually slow heartbeat which may lead to blackouts, shortness of breath, irregular heartbeat and in severe cases heart failure and cardiac arrest. Neonatal lupus is estimated to be responsible for 85% of congenital heart block cases where there is no structural issues with the heart. Congenital heart block may be detected on an echocardiogram as early as 18 weeks of fetal development.
Skin Rash: With neonatal lupus, the skin rash is usually present after birth, commonly within the first couple months of the newborn’s life. The typical rash usually appears around the face, eyes and scalp and can be triggered by sun exposure. It consists of red scaly skin lesions and resembles the rash with SLE. It appears that newborn girls are slightly more susceptible to the skin rash. The rash is not permanent, but in some rare cases skin lesions may persist into childhood. Back to top
If congenital heart block is detected, and there are no other structural issues with the heart, a diagnosis of neonatal lupus is usually expected. After a baby is born, they may be tested for anti-Ro or anti-La antibodies to confirm the diagnosis. Back to top
Treatment for neonatal lupus depends on which symptoms are present. Most skin issues associated with the disease respond well to topical steroids or need no treatment at all. Those individuals with congenital heart block should have regular heart check ups and some may require a pacemaker. However, if there are no signs of cardiac issues at birth, the child may not need any further cardiac evaluation. Back to top
The good news is that only 2 percent of babies born to mother who have lupus will develop neonatal lupus. Other good news is that there is no evidence that babies with neonatal lupus will develop SLE or other types of lupus later in life. Although permanent, the long-term prognosis for children with heart block is good. And for those babies who only have skin issues of neonatal lupus, the long-term prognosis is excellent.
If you, or anyone else you know has a baby with neonatal lupus, you are not alone. For more information about clinical trials being conducted at the NIH (National Institute of Child Health) contact [email protected]. Back to top
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