Which lupus related autoantibodies can cause problems for a fetus during pregnancy?
Antibodies to Ro/SSA, especially when directed against the 52-kD component, have been associated with neonatal lupus syndrome. This can also occur in any woman who makes these antibodies regardless of whether she has autoimmune disease or not. Antibodies to La/SSB have also less commonly been associated with this syndrome. Patients with primary Sjögren’s syndrome who have these autoantibodies are also at increased risk for having a baby with neonatal lupus syndrome.
aPLAs have been associated with increased risk of recurrent first trimester spontaneous abortion and stillbirths, preeclampsia, intrauterine growth restriction, and preterm birth. One hypothesis for this complication is that complement activation leading to influx of inflammatory cells results in thrombosis and placental insufficiency. Anticoagulation with unfractionated or low molecular weight heparin can dramatically improve obstetric outcomes (80% live birth rates) probably due to their anticomplement effect. Rarely neonatal APS due to transplacental passage of aPLAs may occur. There may be an increased risk of neurocognitive delay in children born to mothers with APS, perhaps due to microvascular insult on developing neural tissue.
Antiplatelet antibodies can occasionally cause autoimmune thrombocytopenia in the fetus with associated hemorrhage, especially at the time of delivery. The management of this complication can be difficult.
