Molecular Mechanisms of Fetal and Neonatal Lupus: A Narrative Review of an Autoimmune Disease Transferal across the Placenta

Int J Mol Sci. 2024 May 10;25(10):5224. doi: 10.3390/ijms25105224.

Abstract

This study, conducted by searching keywords such as "maternal lupus", "neonatal lupus", and "congenital heart block" in databases including PubMed and Scopus, provides a detailed narrative review on fetal and neonatal lupus. Autoantibodies like anti-Ro/SSA and anti-La/SSB may cross the placenta and cause complications in neonates, such as congenital heart block (CHB). Management options involve hydroxychloroquine, which is able to counteract some of the adverse events, although the drug needs to be used carefully because of its impact on the QTc interval. Advanced pacing strategies for neonates with CHB, especially in severe forms like hydrops, are also assessed. This review emphasizes the need for interdisciplinary care by rheumatologists, obstetricians, and pediatricians in order to achieve the best maternal and neonatal health in lupus pregnancies. This multidisciplinary approach seeks to improve the outcomes and management of the disease, decreasing the burden on mothers and their infants.

Keywords: autoantibodies; congenital heart block; neonatal lupus erythematosus.

Publication types

  • Review

MeSH terms

  • Autoantibodies / immunology
  • Female
  • Heart Block / congenital
  • Heart Block / immunology
  • Heart Block / therapy
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Infant, Newborn
  • Lupus Erythematosus, Systemic* / congenital
  • Lupus Erythematosus, Systemic* / immunology
  • Lupus Erythematosus, Systemic* / therapy
  • Maternal-Fetal Exchange
  • Placenta* / immunology
  • Placenta* / metabolism
  • Pregnancy
  • Pregnancy Complications / immunology
  • Pregnancy Complications / therapy

Substances

  • Autoantibodies
  • Hydroxychloroquine

Supplementary concepts

  • Neonatal Systemic lupus erythematosus
  • Congenital heart block

Grants and funding

This manuscript received no external funding.