UNPREDICTABLE NATURE AND OUTCOMES IN PREGNANCIES COMPLICATED WITH SLE. POSSIBILITY OF A FAVORABLE OUTCOME IN SUBSEQUENT PREGNANCIES
Journal
Македонски медицински преглед = Macedonian medical review
Date Issued
2025-04
Author(s)
Filipovska Rafajlovska, Marijana
Kapushevska, Dobrila
Sarachini Hajdari, Shqipe
Kacarska Mickoska, Milena
Abstract
Systemic lupus erythematosus (SLE) is chronic inflammatory connective tissue disease that mainly
affects women in reproductive age. This autoimmune disorder significantly impacts pregnancy
outcomes. Patients with SLE are at increased risk of complications such as spontaneous abortion,
intrauterine fetal demise, preterm delivery, preeclampsia, intrauterine growth restriction and
neonatal lupus including congenital heart block. This case report describes a 34-year-old pregnant
patient with her third pregnancy and a history of SLE, diagnosed during her second pregnancy
that was complicated by fetal atrio-ventricular block of III-rd degree that required neonatal
pacemaker implantation at birth. During her current pregnancy she has been closely monitored
due to her previous history. The maternal autoantibody profile showed elevated levels of antiRo/SAA and anti-La/SSB antibodies, similar to her second pregnancy. However, fetal
echocardiography at 20-28weeks of gestation showed no signs of heart block. The pregnancy
progressed to full term without any serious complications. The neonate was without physical and
biochemical signs of neonatal lupus. This report highlights the role of biomarkers and clinical
management strategies in predicting and preventing fetal complication, as well as the variable
outcomes in subsequent pregnancies. It demonstrates the complex and unpredictable nature of
pregnancy in women with SLE. Although the patient had elevated anti-Ro/SSA and anti-La/SSB
antibodies, her last pregnancy did not result in the expected complication of fetal AV block or
neonatal lupus. This shows the high range of variability in the manifestation of neonatal lupus
and congenital heart block even in pregnancies in the same women.
affects women in reproductive age. This autoimmune disorder significantly impacts pregnancy
outcomes. Patients with SLE are at increased risk of complications such as spontaneous abortion,
intrauterine fetal demise, preterm delivery, preeclampsia, intrauterine growth restriction and
neonatal lupus including congenital heart block. This case report describes a 34-year-old pregnant
patient with her third pregnancy and a history of SLE, diagnosed during her second pregnancy
that was complicated by fetal atrio-ventricular block of III-rd degree that required neonatal
pacemaker implantation at birth. During her current pregnancy she has been closely monitored
due to her previous history. The maternal autoantibody profile showed elevated levels of antiRo/SAA and anti-La/SSB antibodies, similar to her second pregnancy. However, fetal
echocardiography at 20-28weeks of gestation showed no signs of heart block. The pregnancy
progressed to full term without any serious complications. The neonate was without physical and
biochemical signs of neonatal lupus. This report highlights the role of biomarkers and clinical
management strategies in predicting and preventing fetal complication, as well as the variable
outcomes in subsequent pregnancies. It demonstrates the complex and unpredictable nature of
pregnancy in women with SLE. Although the patient had elevated anti-Ro/SSA and anti-La/SSB
antibodies, her last pregnancy did not result in the expected complication of fetal AV block or
neonatal lupus. This shows the high range of variability in the manifestation of neonatal lupus
and congenital heart block even in pregnancies in the same women.
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