Pregnancy outcome in 100 women with autoimmune diseases and anti-Ro/SSA antibodies: a prospective controlled study

Abstract

Anti-Ro/SSA antibodies are associated with neonatal lupus but are also considered a possible cause for unexplainedpregnancy loss and adverse pregnancy outcome. In a large multicentres cohort study we have prospectivelyfollowed 100 anti-Ro/SSA positivewomen (53 systemic lupus erythematosus (SLE)) during their 122 pregnancies and 107 anti-Ro/SSA negative women (58 SLE) (140 pregnancies).Anti-Ro/SSA antibodies were tested by immunoblot and counterimmunoelectrophoresis. Mean gestational age at delivery (38 vs 37.9 weeks), prevalence of pregnancy loss (9.9 vs 18.6%), preterm birth (21.3 vs 13.9%), cesarean sections (49.2 vs 53.4%), premature rupture of membranes(4.9 vs 8.1%), preeclampsia(6.6 vs 8.1%), intrauterinegrowth retardation(0 vs 2.3%) and newborns small for gestationalage (11.5 vs 5.8%) were similar in anti-Ro/SSA positive and negative SLE mothers; findings were similar in non-SLE women. Two cases of congenital heart block were observed out of 100 anti-Ro/SSA positive women. In conclusion, anti-Ro/SSA antibodies are responsiblefor congenitalheart block but do not affect other pregnancyoutcomes,both in SLE and in non-SLE women. The general outcome of these pregnancies is now very good, if prospectively followedby multidisciplinaryteams with ample experiencein this field.

Keywords

anti-Ro/SSA antibodies congenital heart block pregnancy primary Sjogren's syndrome systemic lupus erythematosus

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References

Brucato A , Buyon JP , Horsfall AC , Lee LA , Reichlin M . Fourth international workshop on neonatal lupus syndromes and the Ro/SSA-La/SSB System . Clin Exp Rheumatol 1999; 17: 130–136 .

Hull RG , Harris EN , Morgan SH , Hughes GR . Anti-Ro antibodies and abortions in women with SLE . Lancet 1983; 2: 1138-1138 .

Barclay CS , French MA , Ross LD , Sokol RJ . Successful pregnancy following steroid therapy and plasma exchange in a woman with anti-Ro (SS-A) antibodies. Case report . Br J Obstet Gynaecol 1987; 94: 369–371 .

Watson RM , Braunstein BL , Watson AJ , Hochberg MC , Provost TT . Fetal wastage in women with anti-Ro(SSA) antibody . J Rheumatol 1986; 13: 90–94 .

Julkunen H , Kaaja R , Kurki P , Palosuo T , Friman C . Fetal outcome in women with primary Sjogren's syndrome. A retrospective case-control study . Clin Exp Rheumatol 1995; 13: 65–71 .

Mavragani CP , Dafni UG , Tzioufas AG , Moutsopoulos HM . Pregnancy outcome and anti-Ro/SSA in autoimmune diseases: a retrospective cohort study . Br J Rheumatol 1998; 37: 740–745 .

Le Thi HD , Wechsler B , Piette JC , Bletry O , Godeau P . Pregnancy and its outcome in systemic lupus erythematosus . Q J Med 1994; 87: 721–729 .

Brucato A , Frassi M , Franceschini F et al. Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women . Arthritis Rheum 2001; 44: 1832–1835 .

Hochberg MC . Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum 1997; 40: 1725-1725 .

10.

Vitali C , Bombardieri S , Moutsopoulos HM et al. Preliminary criteria for the classification of Sjogren's syndrome. Results of a prospective concerted action supported by the European Community . Arthritis Rheum 1993; 36: 340–347 .

11.

Johnson MJ . Obstetric complications and rheumatic disease . Rheum Dis Clin N Am 1997; 23: 169–182 .

12.

Clark G , Reichlin M , Tomasi TB Jr. Characterization of a soluble cytoplasmic antigen reactive with sera from patients with systemic lupus erythmatosus . J Immunol 1969; 102: 117–122 .

13.

Brucato A , Franceschini F , Gasparini M et al. Isolated congenital complete heart block: longterm outcome of mothers, maternal antibody specificity and immunogenetic background . J Rheumatol 1995; 22: 533–540 .