ANTENATAL DIAGNOSIS OF FETAL HEART RHYTHM DISORDERS IN WOMEN WITH LUPUS WITH POSITIVE ANTI-SSA AND ANTI-SSB ANTIBODIES: ABOUT TWO CASES

Abstract

Lupus erythematosus is a nonorgan-specific autoimmune disease predominantly affecting young women of childbearing age, as well as neonatal lupus is a complication related to the presence of anti-SSA/Ro or anti-SSb/La antibodies in the mother. Cardiac manifestations of neonatal lupus include anti-SSA/Ro-SSB/La-mediated conduction system disease and endocardial/myocardial damage resulting in cardiomyopathy. Pregnancy is a complicating factor in lupus erythematosus in 60% of cases. These complications do not seem to be related to the number of pregnancies or to the duration of remission, but stopping the hydroxychloroquine treatment could be the cause of relapses. Obstetrical complications due to lupus are dominated by intrauterine growth retardation and prematurity in 30% of cases, abortion or fetal death in utero in 20% of cases, especially in the presence of anti-phospholipid antibodies and/or anti-cardiolipin antibodies in the mother, and complete atrioventricular block in 1.6% of cases due to trans-placental passage of anti-SSA antibodies. Some treatments, including hydroxychloroquine, corticosteroids, and certain immunosuppressants (azathioprine) are safe, and can and should be maintained if necessary during pregnancy.