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I have lupus. Will my baby have lupus too?
It's very unlikely. Lupus (systemic lupus erythematosus, or SLE) isn't an infection, so your baby can't catch it from you.
But lupus does run in families, so the genes that make you more likely to develop lupus could be passed on. Research shows that when one identical twin develops lupus, there's a significantly higher chance the other twin will get it too.
Lupus is also more common in some ethnic groups. For example, you're more likely to develop lupus if you're African American, Native American, or an Alaska Native.
It's unknown exactly what causes lupus, but it's most likely a combination of factors. Lupus doesn't typically develop until adulthood, so it could be that genes, hormones (particularly estrogen), and environment all play a part.
What problems could my baby have because of lupus?
Many women with lupus give birth to a healthy baby without any complications, especially if lupus has been in remission for at least six months before pregnancy. But the likelihood of complications is higher if lupus is active at the time of conception, or when it affects the kidneys or other major organs. Having lupus increases the risk of:
- Intrauterine growth restriction (IUGR)
- Preterm birth
- Pregnancy loss (miscarriage)
Also, some women have problems with the proteins in blood that fight disease by activating the body's immune system (antibodies).
Between one-quarter to one-half of people with lupus have problems with antiphospholipid antibodies. When the immune system attacks these antibodies, the risk of certain complications increase, such as:
- Blood clots (thrombosis)
- Pregnancy loss (miscarriage)
- Preterm delivery
- Low birth weight
If you have lupus, it's also possible to develop Anti-Sjögren’s-syndrome-related antigen A (anti-SSA) and anti-Sjögren’s-syndrome-related antigen B (anti-SSB) antibodies. These antibodies can cause complications for a baby, including neonatal lupus and congenital heart block.
What is neonatal lupus?
Neonatal lupus is a rare condition that can affect a baby born to a mother with lupus. It develops in babies born to women with certain autoimmune conditions, like lupus, as well as to women with other autoimmune conditions that produce the same antibodies.
Neonatal lupus isn't true lupus because the baby doesn't produce the antibodies that cause lupus, such as anti-SSA or anti-SSB antibodies. Rather, neonatal lupus is a reaction to the mother's anti-SSA or anti-SSB antibodies, and the condition usually goes away on its own.
When you're pregnant, your antibodies normally travel across the placenta and prevent infections and viruses in your baby. A baby needs these antibodies after birth because it takes a few months for an infant's immune system to kick in.
Unfortunately, antibodies from people with autoimmune diseases can also pass to an unborn baby. When this happens, these autoantibodies – like the anti-SSA and anti-SSB antibodies – mistakenly attack the baby's healthy tissue.
But neonatal lupus is very rare: Only 1 to 2 percent of infants born to mothers with anti-SSA or anti-SSB antibodies develop signs of neonatal lupus. The most common symptom is a skin rash, which appears on a baby's head or around his eyes, or on the arms, trunk, or legs. The rash occurs at birth or within a few months after birth and is sometimes triggered by sunlight.
Low blood platelets (thrombocytopenia) and liver abnormalities (hepatitis) are also associated with neonatal lupus. In almost all cases, these problems go away as soon as the baby clears the mother's antibodies from his system, usually when the baby is about 6 months old.
What is a congenital heart block?
Congenital heart block is when the electrical signals controlling a baby's heart rate are disrupted and the heart beats more slowly than normal. This is the most serious problem associated with neonatal lupus. Although congenital heart block can be mild, it can also be life-threatening.
Congenital heart block affects about 1 to 2 percent of babies born to a mother who has anti-SSA or anti-SSB antibodies, and it usually develops between 18 and 24 weeks of pregnancy. If you have anti-SSA or anti-SSB antibodies, your provider will monitor your baby's heartbeat regularly because of the risk of fetal heart block.
Although there's no known treatment for a congenital heart block, your baby's provider will also monitor your baby for heart failure. (You may be advised to deliver at a specialized center.)
After birth, your baby will continue to be monitored closely. Most babies who have congenital heart block need to get a pacemaker for the best chance of being healthy and living a full life.
Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.