Rheumatic disease in pregnancy and fetal side effects

pregnancy-induced changes in immune function may affect the connective tissue disease (CTD) itself, for example, increased risk of flare in lupus pregnancy or pregnancy- induced remission in rheumatoid arthritis (RA) patients.

autoimmune dysfunction that characterizes particular CTDs can affect maternal or fetal outcome, particularly presence of antiphospholipid antibodies, which may lead to increased risk of miscarriage, fetal loss, and preeclampsia

Transplacental passage of pathogenic autoantibodies can directly affect the fetus, notably anti–Ro/SS-A and La/SS-B, which may lead to neonatal lupus erythematosus

severe maternal illness or preexisting damage from autoimmune disease can have a significant effect on both maternal and fetal or neonatal outcomes

ANTIPHOSPHOLIPID ANTIBODY

The most common adverse events related to neonatal outcome are prematurity and IUGR. Prematurity is most common in patients who have both APS and SLE

LUPUS PREGNANCY

There are certain factors that stand out in terms of increasing risk for lupus pregnancy: these include having active disease at the time of conception, having prior or active nephritis, and having antiphospholipid antibodies

In terms of neonatal outcome, high levels of disease activity and lower complement levels in the setting of more active disease have been shown to predict small size and early delivery

Proteinuria, thrombocytopenia, aPL, and hypertension at the first visit have also been shown to be predictors of pregnancy morbidity.

Active disease, high titer aPL, and high uric acid were associated with adverse outcomes

NEONATAL LUPUS ERYTHEMATOSUS

Neonatal lupus erythematosus is associated with the presence of anti-Ro and La, or SS-A and SS-B, antibodies, and is not related to an underlying diagnosis of lupus or Sjögren syndrome: a number of the anti–Ro/SS-A– positive mothers are asymptomatic at the time of the birth

The risk for any manifestation of neonatal lupus is about 20%, including photosensitive rash, hepatitis, thrombocytopenia, or congenital heart block

The risk of complete heart block (CHB) is 2% to 3%. But in a high-risk patient—one who has had a child with neonatal lupus of any type— the risk for CHB increases to 17%.

With the exception of heart block, most neonatal lupus erythematosus symptoms resolve when maternal antibody clears at 3 to 6 months of life

The mortality rate with CHB is 20%, usually because of associated inflammation including hydrops or myocarditis

Most surviving patients require pacemakers

Current recommendations for the high-risk patient are fetal echoes weekly from 16 to 26 weeks and every 2 weeks thereafter until 34 weeks.

Treatment with corticosteroid such as dexamethasone is still suggested for evidence of atrioventricular block, pericarditis, or other myocardial inflammation, although response is controversial. Dexamethasone passes through the placenta almost completely.

Intravenous immunoglobulin has been studied but, unfortunately, does not seem to be protective against the development of heart block

Hydroxychloroquine may be protective

RHEUMATOID ARTHRITIS

Most RA patients feel better during pregnancy and have a high likelihood of good pregnancy outcome

Overall, the pregnancy outcome is very good in RA. In general, well-controlled RA outcome is comparable to the general population

In recent years, however, a number of studies suggest a small but significant increase in the risk of lower birth weight and preterm delivery for RA patients who have active disease during the pregnancy, with a slight increase in perinatal mortality and higher frequency of cesarean deliveries

Sjögren Syndrome

Maternal age was higher, birth weights slightly lower, and the cesarean delivery rate a bit greater than expected. The major pregnancy risk is neonatal lupus

Systemic Sclerosis

Pregnancy is far less common in systemic sclerosis patients than in patients with SLE or RA because of average older age at onset for systemic sclerosis

Miscarriage risk is increased in long-standing diffuse disease. Fetal outcome is overall good, although there is an increased risk of preterm birth and smaller infants

Polymyositis and Dermatomyositis

Patients with new disease onset during pregnancy have a high risk of losing the fetus; for patients with established disease in remission, there is a risk of flare, but fetal survival is 80%.

Systemic Vasculitis

There are few reported cases of systemic vasculitis in pregnancy because of the older age at onset and male predominance for most of the vasculitides

There is an increased risk of miscarriage and preterm birth

Effects of preeclampsia on the fetus and child

The main impact on the fetus is undernutrition as a result of utero-placental vascular insufficiency, which leads to growth retardation

Fetal health as well as its weight are highly compromised, leading to various degrees of fetal morbidity, and fetal damage may be such as to cause fetal death

babies who suffered intrauterine growth retardation are more likely to develop hypertension, coronary artery disease, and diabetes in adult life

Unusual perinatal complications involving anoxia or catecholamine release in the mother, fetus, or newborn may predispose the baby to the development of precocious coronary atherosclerosis later in life

magnesium sulfate for preeclampsia side effects

Magnesium sulfate is the drug of choice for prevention of seizures in the pre-eclamptic woman, or prevention of recurrence of seizures in the eclamptic woman

Newborns may show signs of magnesium toxicity (i.e. respiratory and/or neuromuscular depression) if the mother has received intravenous magnesium sulfate prior to delivery

Meconium Plug Syndrome in Neonate Following Administration of Magnesium Sulfate for Mother

Prematurity is a term for the broad category of neonates born at less than 37 weeks' gestation

Preterm birth is the most common cause of death among infants worldwide

Neurological problems include apnea of prematurity, hypoxic-ischemic encephalopathy (HIE), retinopathy of prematurity (ROP), developmental disability, transient hyperammonemia of the newborn, cerebral palsy and intraventricular hemorrhage

Children born preterm are more likely to have white matter brain abnormalities early on causing higher risks of cognitive dysfunction

Cardiovascular complications may arise from the failure of the ductus arteriosus to close after birth: patent ductus arteriosus (PDA)

Respiratory problems are common, specifically the respiratory distress syndrome (RDS ) (previously called hyaline membrane disease). Another problem can be chronic lung disease (previously called bronchopulmonary dysplasia or BPD).

Gastrointestinal and metabolic issues can arise from neonatal hypoglycemia, feeding difficulties, rickets of prematurity, hypocalcemia, inguinal hernia, and necrotizing enterocolitis (NEC).

Hematologic complications include anemia of prematurity, thrombocytopenia, and hyperbilirubinemia (jaundice) that can lead to kernicterus

Infection, including sepsis, pneumonia, and urinary tract infection