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Obstetrics & Gynecology 1999;93:952-957
© 1999 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Neonatal Lupus Erythematosus: Results of Maternal Corticosteroid Therapy

KOJI SHINOHARA, MD, SACHIKO MIYAGAWA, MD, TOMIO FUJITA, MD, TOSHIHIRO AONO, MD and KIN-ICHI KIDOGUCHI, MD

From the Department of Obstetrics and Gynecology, University of Tokushima School of Medicine, Tokushima; Department of Dermatology, Nara Medical University, Nara; Department of Maternal Medicine, Osaka Medical Center, and the Research Institute for Maternal and Child Health, Osaka, Japan.

Address reprint requests to: Kin-ichi Kidoguchi, MD Department of Maternal Medicine, Osaka Medical Center and the Research Institute for Maternal and Child Health 840 Murodo, Izumi Osaka, 594-1101 Japan

Objective: To assess the possibility of preventing cardiac or cutaneous manifestations of neonatal lupus erythematosus or treating the fetus with congenital heart block by administering corticosteroid therapy to the mother.

Methods: Eighty-seven offspring of 40 anti-Ro/SSA-positive mothers, followed up from 1979 to 1996, were evaluated. Autoantibodies against Ro/SSA and La/SSB antigens were detected by immunodiffusion and enzyme-linked immunosorbent assay.

Results: None of 26 neonates whose mothers received corticosteroid maintenance therapy initiated before 16 weeks’ gestation demonstrated congenital heart block, whereas 15 of 61 neonates whose mothers received no corticosteroids during pregnancy or began receiving steroid therapy after 16 weeks’ gestation had congenital heart block. Complete congenital heart block, once developed, did not respond to corticosteroid treatment in utero. Four infants whose mothers received steroid treatment before 16 weeks’ gestation had skin lesions of neonatal lupus erythematosus.

Conclusion: Once established, complete congenital heart block was irreversible and maternal corticosteroid therapy did not effectively prevent cutaneous lupus erythematosus. However, prenatal maintenance therapy with prednisolone or betamethasone given to the mother starting early in pregnancy (before 16 weeks’ gestation) might reduce the risk of developing antibody-mediated congenital heart block in the offspring.




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