OBJECTIVE: to evaluate the frequency of neonatal lupus, prematurity, fetal loss, and low weight in pregnancies of SLE patients attended at a tertiary health service. MEHTODS: it is a retrospective study evaluating all SLE patients attended at obstetric center of Hospital São Paulo/Unifesp/EPM from November, 1991 to April, 2003. The mother and children's clinical and laboratory data were obtained reviewing medical records. RESULTS: sixty women and 75 pregnancies were identified. The mother age average during the pregnancies was 27.1±6.1 years old and the median of disease duration was 48 months. Two patients needed to be submitted to dialysis during the pregnancy. Sixty-three patients used prednisone, 4 received methilprednisolone pulsetherapy and 2 received azathioprine during the pregnancy. During the first trimester of pregnancy, 6 patients received diphosphate chloroquine and 2 received hidroxychloroquine. Two patients unknowing pregnancy received pulse of cyclophosphamide and another one had used methotrexate and both presented spontaneous abortion. It was observed 13 cases of intrauterine death and 7 abortions. Preterm birth occurred in 57% of pregnancies and the average duration of gestation was 35 weeks. The mean weight of the newborns was 2,332±961g (ranging from 525 to 3,620g). Five cases of neonatal lupus were identified (8,9%). One with congenital heart block (CHB) had intrauterine death at the 29th week of gestation, had 3 babies with thrombocytopenia associated with anti-Ro/SSA antibodies and one with neutropenia associated with anti-RNP antibody. Excepting the case of CHB with intrauterine death, these antibodies were detected on maternal and newborn blood sample. At the end of the study, it was detected two deaths of children with 9 and 130 days of life, due to complications related to prematurity. CONCLUSIONS: comparing with published reports this study showed a similar frequency of fetal loss (abortion and intrauterine death), however the frequency of prematurity was higher than the mean reported in the literature. Hematological features of neonatal lupus, as leucopenia and thrombocytopenia were observed at higher frequency than reported in the literature. As transitory and asymptomatic features, they could have been under-diagnosed.
neonatal lupus; anti-Ro/SS-A antibody; anti-La/SS-B antibody; congenital heart block
