Systemic lupus erythematosus (SLE) is an important risk factor for mothers during pregnancy and the puerperal period. Lupus women are thought to experience disease deterioration due to pregnancy, but varying incidence rates have been reported.

!aternal lupus is known to influence fetal and neonatal outcomes and is associated with increased incidence of obstetric complications such as stillbirth, abortion, prematurity, intrauterine growth restriction ("#$%), and neonatal complications such as congenital heart block and neonatal lupus.&' "n particular, mothers with increased SLE activity, lupus nephritis, hypertension, and who are positive for antiphospholipid and anti&%o( SS&) antibodies have relatively poor fetal and neonatal prognosis. *owever, few studies have investigated the neonatal prognosis in SLE mothers who delivered at full term without obstetrical complications.

+ur study focused on the effects of SLE on perinatal outcome by comparing clinical features of full&term neonates born to lupus mothers and normal pregnant women.,his retrospective study investigated medical records of sub-ects. ,he lupus and control groups were compared with respect to gestational age, birth weight, days ofhospital stay, S$), )pgar score, and parity. "n the lupus group, ).) titers and platelet count were assessed at birth, and electrocardiogram monitoring was performed until discharge. ).)&positive neonates were followed p until conversion to negative was confirmed.+n the other hand, based on the maternal ).) titers prior to delivery, the lupus group was divided into / sets of subgroups0 (i) cases with anti&ds1.) antibody values greater than 22 "#(mL (2 neonates) and cases with values lower than 22 "#(mL (3) and (ii) cases positive for antiphospholipid autoantibody (4) or negative cases (//). ,he respective subgroups were compared with respect to &min and 5&min )pgar scores less than 6, birth weight, gestational age, S$) fre7uency, and platelet count.)ntiphospholipid antibody&positive cases were defined as those that were positive for any of the following0 anticardiolipin antibody, lupus anticoagulant, or 81%L (the positive 81%L result was a false positive).).) testing was performed in 6 neonates in the lupus group9 2 neonates were tested positive for anti&ds1.) antibodies at birth and converted to negative at 4 & / month after birth. )nti&%o(SS&) and anti&La(SS&: antibodies were detected in 5and ' neonates, respectively (,able '). ,hree cases were tested positive for %o(SS&) and La(SS&: autoantibodies in concomitance.,able 'Laboratory ;indings of Lupus $roup.one of the neonates showed congenital heart block on electrocardiogram at birth and during the monitoring period or developed neonatal lupus due to ).) transmission from the mother.)mong the pregnant women in the lupus group, thrombocytopenia (platelet count of mother < 22,222(mm') was observed in 6 women (/5.=>) and / of their neonates (platelet count of neonate < 52,222(mm'). "n all, 5 neonates showed thrombocytopenia (platelet count of neonate < 52,222(mm'), and they recovered within ? days after birth without any special treatment.Lupus mothers have a high risk of experiencing spontaneous abortion, stillbirth, prematurity, and "#$%.&? "n ==', @etri et al.5 examined ?3 neonates born to /2' lupus women and the incidence of spontaneous abortion and stillbirth was /> andprematurity was />. ,hese incidence rates were significantly higher than those inhealthy pregnant women. "n /222, $eorgiou et al.4 reported that, among the 5= neonates born to ?6 lupus mothers, 5> were born prematurely. "n our study, '6 lupus women delivered '= neonates of which 3 (/2.5>) were born prematurely. ,his is a very high rate when compared with the prematurity rate of 2.=> (= in ,222 deliveries) reported by the Aorea .ational Statistical +ffice in /225. %egarding the parity of the lupus group (/3 neonates), there were / abortions (?3>) and ? premature deliveries (4>) among a total of /5 pregnancies, whereas there were '/ abortions (?/.4>) and ' premature deliveries (?>) among a total of 65 pregnancies in the control group. ,hus, the fre7uency of prematurity and abortion was higher in the lupus group than the control group, however, a statistically significant difference was not observed. "n another Aorean report6investigating the parity of = lupus women from ==2 to ==4, the fetal loss was =.6> and prematurity rate was '5.4>. ,he rates observed in the present study were lower, which might be due to the inclusion of lupus mothers with full&term deliveries.@oor neonatal prognosis has been reported in lupus women with disease deterioration, ).)&positive status, or increased ).) titers.3,= *owever, in our study, a significant difference in neonatal prognosis was not observed between the / lupus subgroups based on anti&ds1.) antibody titers B 22 and < 22. ,his could due to the fact that sub-ects were restricted to healthy full&term neonates bornto mothers without preeclampsia. ,he presence of a@L in lupus mothers is '2 & ?2>,/ and this is associated with fre7uent abortion, "#$%, oligohydramnios, preeclampsia, stillbirth, and *ELL@ syndrome.&?,2 "n /22', !oroni et al.

reported a strong possibility of lupus mothers positive for a@L or with nephritis losing their fetuses due to factors such as stillbirth and abortion, and the incidence of abortion varied from '2> to 3'>. "n comparison, in lupus mothers without a@L, the incidence of abortion was ? & ?'>, which was lower than that in mothers positive for these antibodies. *owever, it has been reported that chances of stillbirth or abortion in mothers positive for a@L could be reduced by aspirin or heparin treatment.2 "n our study, among the /3 neonates, maternal a@L were detected in 4 cases (/.?>) and there were only / abortions (''.'>). "n // mothersnegative for a@L, 2 (?5.?>) had a history of abortion. ,hus, our results differ from those reported by !oroni in /22'. "n addition, a comparison of pregnant women testing positive (4 neonates) and negative (// neonates) for a@L showed nodifferences in )pgar scores of neonates, birth weight, gestational age, S$) fre7uency, and platelet count. *owever, it appears to be necessary to conduct additional studies with a larger number of sub-ects."t has been reported that besides a@L, the presence of ).)s during pregnancy mayaffect the prognosis of the perinatal period./ "n particular, anti&%o(SS&) and anti&La(SS&: antibodies were associated with neonatal lupus/ and congenital heart block, but, they were not associated with stillbirth, abortion, and prematurity.'!any lupus mothers take medications during pregnancy. Steroids are relatively safe in pregnant women,/ and it has been reported that fetal mortality and morbidity rates decreased in lupus mothers when treated with steroids.? *owever, !olad et al.

have reported in /225 that not only high lupus activity but also hypoalbuminemia, proteinuria, presence of ).)s, and history of drugs such as steroids and hydroxychloro7uine could be risk factors in lupus mothers. "n our study, /5 among the /6 lupus women (=/.4>) had received systemic steroid treatment, but, it could not be determined whether this acted as an advantageous factor in maintaining the pregnancy to full term."n our study, 5 among the /3 lupus neonates showed thrombocytopenia with platelet counts in the range of 3',222 to ?=,222(mm'. @latelet count became normal within / weeks in most cases, and administration of immunoglobulin or other drugs was not re7uired. +ur findings were different from those of other reports5 in that the problem of thrombocytopenia was not greatly enhanced. ,his isthought to be due to the inclusion of full&term neonates and low&risk pregnancy sub-ects without complications such as preeclampsia and prematurity."n a Aorean study onneonates born to = SLE women, = women had a total of '2pregnancies among which there were 4 spontaneous abortions (/2.2>) and 5 stillbirths (4.6>), and among the neonates, ? were born prematurely ('4.?>) and / were S$) (=./>).5 ;rom birth, / neonates showed thrombocytopenia and leucopenia, and / pregnant women positive for lupus anticoagulant and a@L experienced preterm delivery.5,hus, obstetrical complications may develop in lupus women in whom pregnancy is maintained, and their prognosis has been reported to be poor. *owever, few studies have examined the neonatal prognosis in lupus women who delivered at full term."n /225, Coleman et al./ reported that, at birth, a statistical difference was not observed in the weight and height of /' neonates born to lupus women and 5 neonates born to healthy mothers. ,he explanation provided for this result was that the number of sub-ects in the lupus group was small, and factors influencing the prognosis of pregnant women such as nutrition, parity, and maternal comorbidity were not assessed. *owever, in our study, a comparison of the lupus group, in which pregnancy was maintained to full term by administering prenatal care for diverse obstetrical complications with the control group showed that birth weight and gestational age of the lupus group were lower and incidence of S$) was higher.,he perinatal prognosis of lupus mothers is poor in comparison with normal pregnant women. ,herefore, even if the pregnancy could be maintained until full term by avoiding obstetrical complications that might develop during pregnancy and delivery, cautious evaluation and treatment of the neonates are essential.