UNPREDICTABLE NATURE AND OUTCOMES IN PREGNANCIES COMPLICATED WITH SLE. POSSIBILITY OF A FAVORABLE OUTCOME IN SUBSEQUENT PREGNANCIES

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.