Dr. Evelyne Vinet
CHICAGO—Women with systemic lupus erythematosus (SLE) are at higher risk of maternal and fetal complications than those in the general population. These risks are shared to varying degrees by other systemic autoimmune rheumatic diseases, such as Sjögren’s disease. At a session of ACR Convergence 2025, Evelyne Vinet, MD, PhD, associate professor in the Division of Rheumatology at McGill University Health Centre, Montreal, discussed management considerations to optimize outcomes in pregnant patients with SLE.
Initial Risk Stratification
Preconception counseling and risk stratification are important aspects of care, noted Dr. Vinet, although sometimes these patients may not present until after conception. She explained that for women with SLE, clinicians should assess levels of disease activity, extent of disease damage and comorbidities. Positive antibodies for Sjögren’s-syndrome-related antigen A (anti-Ro/SSA), for Sjögren’s-syndrome-related antigen B (anti-La/SSB) or for antiphospholipid antibodies (aPL) also increase risk.
The latter should also be tested in women with suggestive clinical findings who have other rheumatic diseases because they may indicate antiphospholipid syndrome (APS).1 These antibodies are required but not sufficient for diagnosis of the systemic autoimmune syndrome, recently redefined by the 2023 ACR/EULAR classification criteria; APS increases the risk of thrombosis and other factors affecting pregnancy morbidity and fetal loss.2
Current ACR guidelines recommend prenatal or early pregnancy testing for anti-Ro/SSA and anti-La/SBB antibodies not just in patients with SLE, but also in patients with systemic sclerosis, rheumatoid arthritis and Sjögren’s disease.1 Although most commonly positive in the latter group, the presence of these antibodies may trigger neonatal lupus syndrome in any patient with rheumatic disease who is positive for these antibodies, and sometimes even in antibody-positive females without a previously diagnosed autoimmune rheumatic condition.3
Dr. Peter Izmirly
Another presenter at the session, Peter Izmirly, MD, a rheumatologist and professor of medicine at New York University Grossman School of Medicine, New York, discussed the poorly named neonatal lupus syndrome, which does not cause true SLE in the child. The transfer of anti-Ro/SSA or anti-La/SBB antibodies across the placenta leads to lupus-like symptoms in the infant, such as rash.
Although symptoms are sometimes mild and temporary, congenital heart block is a potentially permanent and serious complication. In patients positive for these antibodies, the risk of neonatal lupus with cardiac involvement is about 2%, with recurrence rates in subsequent pregnancies at about 6 to 10 times this rate.4
