Neonatal lupus erythematosus: Results of maternal corticosteroid therapy

Objective: To assess the possibility of preventing cardiac or cutaneous man ifestations of neonatal lupus erythematosus or treating the fetus with cong enital heart block by administering corticosteroid therapy to the mother. Methods: Eighty-seven offspring of 40 anti-Ro/SSA-positive mothers, followe d up from 1979 to 1996, were evaluated. Autoantibodies against Ro/SSA and L a/SSB antigens were detected by immunodiffusion and enzyme-linked immunosor bent assay. Results: None of 26 neonates whose mothers received corticoster oid maintenance therapy initiated before 16 weeks' gestation demonstrated c ongenital heart block, whereas 15 of 61 neonates whose mothers received no corticosteroids during pregnancy or began receiving steroid therapy after 1 6 weeks' gestation had congenital heart block. Complete congenital heart bl ock, once developed, did not respond to corticosteroid treatment in utero. Four infants whose mothers received steroid treatment before 16 weeks' gest ation had skin lesions of neonatal lupus erythematosus. Conclusion: Once established, complete congenital heart block was irreversi ble and maternal corticosteroid therapy did not effectively prevent cutaneo us lupus erythematosus. However, prenatal maintenance therapy with predniso lone or betamethasone given to the mother starting early in pregnancy (befo re 16 weeks' gestation) might reduce the risk of developing antibody-mediat ed congenital heart block in the offspring. (Obstet Gynecol 1999;93:952-7. (C) 1999 by The American College of Obstetricians and Gynecologists.)