Infants Born to Mothers With Anti-SSA/Ro Autoantibodies: Neonatal Outcome and Follow-up

Zuppa, Antonio Alberto; Fracchiolla, Annalisa; Cota, Francesco; Gallini, Francesca; Savarese, Immacolata; D’Andrea, Vito; Luciano, Rita Paola Maria; Romagnoli, Costantino

doi:10.1177/0009922807307264

Cited by 20 publications

(10 citation statements)

References 25 publications

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“…Sjögren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, or mixed or undifferentiated connective tissue disease, or they can remain completely asymptomatic at the time of childbirth. Antibodies produced by the mother and found in her serum belong to the immunoglobulin G group and enter the fetal bloodstream from the time the placenta is formed, i.e., from the 12th week of pregnancy [2]. These antibodies may trigger a cascade of inflammatory reactions in the fetus and lead to the occurrence of neonatal lupus symptoms.…”

Section: Introductionmentioning

confidence: 99%

An Overview of Neonatal Lupus with Anti-Ro Characteristics

Gryka-Marton

Szukiewicz

Teliga-Czajkowska

et al. 2021

IJMS

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Neonatal lupus erythematosus (NLE) is a syndrome of clinical symptoms observed in neonates born to mothers with antibodies to soluble antigens of the cell nucleus. The main factors contributing to the pathogenesis of this disease are anti-Sjögren Syndrome A (anti-SS-A) antibodies, known as anti-Ro, and anti-Sjögren Syndrome B (anti-SS-B) antibodies, known as anti-La. Recent publications have also shown the significant role of anti-ribonucleoprotein antibodies (anti-RNP). Seropositive mothers may have a diagnosed rheumatic disease or they can be asymptomatic without diagnosis at the time of childbirth. These antibodies, after crossing the placenta, may trigger a cascade of inflammatory reactions. The symptoms of NLE can be divided into reversible symptoms, which concern skin, hematological, and hepatological changes, but 2% of children develop irreversible symptoms, which include disturbances of the cardiac stimulatory and conduction system. Preconceptive care and pharmacological prophylaxis of NLE in the case of mothers from the risk group are important, as well as the monitoring of the clinical condition of the mother and fetus throughout pregnancy and the neonatal period. The aim of this manuscript is to summarize the previous literature and current state of knowledge about neonatal lupus and to discuss the role of anti-Ro in the inflammatory process.

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Section: Introductionmentioning

confidence: 99%

An Overview of Neonatal Lupus with Anti-Ro Characteristics

Gryka-Marton

Szukiewicz

Teliga-Czajkowska

et al. 2021

IJMS

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“…The antenatal prediction of CHB is possible by the evaluation of the "mechanical" PR interval with serial fetal ECHOs, beginning at the 16 th -18 th gestational week, since CHB development usually occurs between 18 and 24 weeks of gestation (1,(27)(28)(29).…”

Section: Prenatal Diagnosis: Fetal Echocardiograms (Echos) For Pr Intmentioning

confidence: 99%

Autoimmune Congenital Heart Block: A Review of Biomarkers and Management of Pregnancy

Carolis

Garufi

et al. 2020

Front. Pediatr.

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Autoimmune Congenital Heart Block (CHB) is an immune-mediated disease due to transplacental passage of circulating anti-Ro/SSA and anti-La/SSB autoantibodies. It occurs in 2% of anti-Ro/SSA-exposed pregnancies, and recurrence rate is nine times higher in subsequent pregnancies. Aim of this review is to identify biomarkers of CHB and treatment strategies. The Ro-system is constituted by two polypeptides targeted by the anti-Ro52 and anti-Ro60 autoantibodies. The central portion of Ro52 (p200), more than the full amino-acid sequence of Ro-52, is recognized to be the fine specificity of anti-Ro associated to the highest risk of cardiac damage. If anti-p200 antibody should be tested, as biomarker of CHB, over standard commercial ELISAs is still debated. Recent studies indicate that type I-Interferon (IFN) can activate fibroblasts in fetal heart. In the mother the anti-Ro/La antibodies activate the type I IFN-signature, and maternal IFN-regulated genes correlate with a similar neonatal IFN-gene expression. Evaluation of maternal IFN-signature could be used as novel biomarker of CHB. The measurement of “mechanical” PR interval with weekly fetal echocardiogram (ECHO) from 16 to at least 24 weeks of gestation is strongly recommended for CHB prenatal diagnosis. However, ECHO screening presents some limitations due to difficult identification of first-degree block and possible occurrence of a complete block from a normal rhythm in few days. Maternal administration of Hydroxychloroquine from the tenth week of gestation, modulating toll-like receptor and autoantibody-dependent type I IFN activation on the fetus, has an important role in preventing CHB in pregnant women with high risk for recurrent CHB.

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“…NLE refers to a clinical spectrum of cutaneous, cardiac, and systemic abnormalities observed in newborn infants whose mothers have autoantibodies against Ro/ SSA and La/SSB [10,[19][20][21][22][23][24]. The condition is rare and usually benign and self-limited, but sometimes it may be associated with serious sequelae, like congenital complete atrioventricular block [24].…”

Section: Introductionmentioning

confidence: 99%

“…The condition is rare and usually benign and self-limited, but sometimes it may be associated with serious sequelae, like congenital complete atrioventricular block [24]. Data from literature on the incidence of the different clinical manifestations of NLS are difficult to compare because they come mostly from retrospective studies or prospective studies, but as yet no systematic follow-up has been carried out [21][22][23]25].…”

Section: Introductionmentioning

confidence: 99%

Infants of mothers with systemic connective tissue disease – serological and clinical status in the first year of life; a pilot study

Sochaczewska¹,

Czeszyńska²,

Fischer³

et al. 2021

polp

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Background: Neonatal lupus erythematosus (NLE) is an uncommon autoimmune disease caused by transplacental passage of maternal antibodies. The aim of the study was to investigate whether antinuclear antibodies (ANA) detected in newborns of mothers with systemic connective tissue disease (SCTD) are present after 6 months of age, and whether they are accompanied by clinical symptoms, the so-called NLE. Material and methods: A prospective pilot study was conducted in a group of 20 full-term newborns (11 males and 9 females) consequently born to mothers with SCTD and 6 newborns (3 males and 3 females) of mothers without autoimmune disease. The infants were examined for symptoms of NLE. The ANA profile was evaluated in newborns and repeated at the age of 7 months by using the indirect immunofluorescence technique. Results: ANA was detected in 16/20 newborns from the study group in titre 1 : 40 to 1 : 2560 and in 4/6 newborns from the control group in titre 1 : 40 to 1 : 320, as well as in 9 of 19 7-months-old babies of SCTD mothers. There were no skin lesions, and elevated liver enzymes were found in 8 newborns and haematological changes in 7 newborns. No pathological changes were found in the ECG examination in the neonatal period in any of the children. Conclusions: Maternal ANAs are detected in newborns and in 7-month-old babies. Despite 80% of ANA detection in the neonatal period of infants of SCTD mothers and 47% detection in 7-month-old babies, there were no evident symptoms of NLE besides some elevated levels of liver enzymes and haematological changes.

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Infants Born to Mothers With Anti-SSA/Ro Autoantibodies: Neonatal Outcome and Follow-up

Cited by 20 publications

References 25 publications

An Overview of Neonatal Lupus with Anti-Ro Characteristics

An Overview of Neonatal Lupus with Anti-Ro Characteristics

Autoimmune Congenital Heart Block: A Review of Biomarkers and Management of Pregnancy

Infants of mothers with systemic connective tissue disease – serological and clinical status in the first year of life; a pilot study

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