Neonatal lupus erythematosus: results of maternal corticosteroid therapy.
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.


CONCLUSIONS
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.
Shinohara
K
K
Department of Obstetrics and Gynecology, University of Tokushima School of Medicine, Japan.
Miyagawa
S
S
Fujita
T
T
Aono
T
T
Kidoguchi
K
K
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001323:Autoantibodies / Q000097:blood; D001324:Autoantigens / Q000276:immunology; D005260:Female; D006327:Heart Block / Q000151:congenital / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D008178:Lupus Erythematosus, Cutaneous / Q000517:prevention & control*; D011247:Pregnancy / Q000276:immunology; D020733:RNA, Small Cytoplasmic; D012261:Ribonucleoproteins / Q000276:immunology; D000097585:SS-B Antigen; D000099207:SS-A Antigen
D000305:Adrenal Cortex Hormones; D001323:Autoantibodies; D001324:Autoantigens; D020733:RNA, Small Cytoplasmic; D012261:Ribonucleoproteins; D000097585:SS-B Antigen; D000099207:SS-A Antigen; C116006:RO60 protein, human