All issues > Volume 36(6); 1993

Original Article

J Korean Pediatr Soc. 1993;36(6):791-804. Published online June 15, 1993.

Outcome in Infants of Mothers with Systemic Lupus Erythematosus

Chang Ryul CR Kim¹, Young Pyo YP Chang¹, Hee Seop HS Kim¹, Mi Jung MJ Kim¹, Byung Il BI Kim¹, Jung-Hwan JH Choi¹, Chong Ku CK Yun¹, Bo Hyun BH Yoon², Hee Chul HC Syn², Syng Wook SW Kim², Seon Yang SY Park³, Hahng H Lee⁴

¹Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea
²Department of Obstetrics, Seoul National University, College of Medicine, Seoul, Korea
³Department of Internal Medicine, Seoul National University, College of Medicine, Seoul, Korea
⁴Department of Pediatrics, Hanyang University, College of Medicine, Seoul, Korea

Abstract

A large proportion of patients with systemic lupus erythematosus(SLE) are women of reproductive age. Their fetal outcome is undoubtedly less favourable than in haelthy women. Although there is no evidence of an increase in congenital anomalies, increased frequencies of miscarriage, stillbirth, growth retardation, and preterm delivery are recognized It mainly depends on the compromise of uteroplacental circulation such as renal disease, hypertension and thrombopoitetic action of antiphos phoipid antibody. Besides a small proportion of the newborn infants get a neonatal lupus syndrome, the most serious component being congenital heart block. This coplication occurs almost exclusively in the offsprint of women with anti-Ro/SSA anibodies. In order to find out the effect on fetus and newborn infants born to SLE mother, we reviewed clinical records of 11 infants born to 9 moters with confiremed or suspected SLE at Seoul National University Hospital between June 1981 and May 1991 The results obtained were as follows: 1) Seven mothers among 9 were confirmed as SLE and 2 were suspected 2) There were 6 spontaneous abortions(20.0%)and 5 stillbirths(16.7%) in 5 mothers among thirty pregnacies of 9 mothers 3) Among 11 newborns, 4(36.4%) were premature and 2(18.2%) were small for gestational age. 4) Six mothers had proteinuria, over 4+, in Albustix. Four of these, including 3 preeclampsia mothers, delivered preterm babies. Two of premature babies were born through Cesarean section due to fetal distress and expierd of hyaline membrane and its complications. The other 2 had therombocytopenia and leukocytopenia at birth. One of these had intractranial hemorrhage at birth and seizure. 5) Ther were 2 mothers who had positive anticardiolipin antibody with SLE or without SLE, One with SLE was continuing positivity of the antibody during pregnancy and delivered premature body who expired of HMD and PDA. The other who had seroconversion to negativity during the first trimester developed intermittently sinus bracycardia without apnea for 3 days 6) Two of 11 newborns had only talipes equinovarus. 7) One mother who had anti-Ro/SSA antibody delivered monozygotic twin. The first baby was neonatal lupus erythematosus with complete heart block and skin pigmentation. All of them were suspected to right aortic arch and Kommerell뭩 diverticulum on echocardiogram. As the above results, SLE mothers can cause serious effect on fetus and newborn when acompanied with active rnal impairment, hypertension and positive antiphospholipid antibody. So we should treat mother with SLE veen during pregnancy and it may give better outcome to mother and fetus. I will be useful for diagnosis and treatment of neonatal lupus erythenatosus that the prenatal test for anti-Ro/SSA antibody, fetal monitoring, fetal echocradiogrma and postnatal close observeation for skin are taken.

Keywords :SLE mother, Fetus, Newborn