Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Neonatal lupus

Jill P Buyon, MD
Section Editors
Thomas JA Lehman, MD
John K Triedman, MD
Joseph A Garcia-Prats, MD
Deputy Editor
Elizabeth TePas, MD, MS


Neonatal lupus (NL) is a passively transferred autoimmune disease. It occurs in about 1 to 2 percent of babies born to mothers with autoimmune disease, primarily systemic lupus erythematosus (SLE) and Sjögren's syndrome, and antibodies to Ro/SSA (Sjögren syndrome type A antigen) and/or La/SSB (Sjögren syndrome type B antigen) [1,2]. However, many cases occur in children of mothers who have the same autoantibodies, but who do not have symptoms of lupus or other autoimmune disease at the time of the baby's birth. About one-half of these mothers go on to develop autoimmune disease (more commonly Sjögren syndrome than SLE) [3]. The most serious complication of NL is complete heart block (about 10 percent have an associated cardiomyopathy at the initial diagnosis or develop it later).


Neonatal lupus (NL) is presumed to result from transplacental passage of maternal anti-Ro/SSA (Sjögren syndrome type A antigen) and/or anti-La/SSB (Sjögren syndrome type B antigen) antibodies. Ro and La molecules are thought to form a single particle that is present in all cells. The precise mechanism of injury to specific tissues such as the skin and heart is not known. The pathogenesis of disease probably involves more than simple transplacental passage of antibodies since the disease is rare, even in mothers who have these antibodies, and there can be discordance of disease even in monozygotic twins [4,5]. Anti-Ro/SSA and anti-La/SSB antibodies are associated with a variety of clinical syndromes in adults. (See "The anti-Ro/SSA and anti-La/SSB antigen-antibody systems".)

Autoantibodies — Several studies have established the association between anti-Ro/SSA and anti-La/SSB antibodies and NL by prospectively monitoring offspring of women with anti-Ro/SSA and anti-La/SSB antibodies as follows:

In a report of 100 women with anti-Ro/SSA antibodies and an autoimmune disease who were prospectively monitored, beginning prior to conception, only two of the mothers had pregnancies that were complicated by congenital complete heart block (detected by fetal echocardiography at 20 and 22 weeks) [6]. The incidence of complete heart block was 2 percent (95% CI 0.5-7.0) in first-observed pregnancies, 1.8 percent of livebirths, and 1.7 percent of all pregnancies.

A similar risk was noted in two other reports. In one series of 124 pregnancies in 112 women with anti-Ro/SSA antibodies, with or without anti-La/SSB antibodies, the risk was 1.6 percent [7]. In another series of women with anti-Ro/SSA, 1 of 99 first-observed pregnancies was complicated by complete heart block [8].


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Feb 2017. | This topic last updated: Sat Oct 04 00:00:00 GMT+00:00 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Brucato A, Cimaz R, Caporali R, et al. Pregnancy outcomes in patients with autoimmune diseases and anti-Ro/SSA antibodies. Clin Rev Allergy Immunol 2011; 40:27.
  2. Buyon JP. Updates on lupus and pregnancy. Bull NYU Hosp Jt Dis 2009; 67:271.
  3. Rivera TL, Izmirly PM, Birnbaum BK, et al. Disease progression in mothers of children enrolled in the Research Registry for Neonatal Lupus. Ann Rheum Dis 2009; 68:828.
  4. Buyon JP, Kim MY, Copel JA, Friedman DM. Anti-Ro/SSA antibodies and congenital heart block: necessary but not sufficient. Arthritis Rheum 2001; 44:1723.
  5. Buyon JP, Clancy RM, Friedman DM. Cardiac manifestations of neonatal lupus erythematosus: guidelines to management, integrating clues from the bench and bedside. Nat Clin Pract Rheumatol 2009; 5:139.
  6. Brucato A, Frassi M, Franceschini F, et al. Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women. Arthritis Rheum 2001; 44:1832.
  7. Cimaz R, Spence DL, Hornberger L, Silverman ED. Incidence and spectrum of neonatal lupus erythematosus: a prospective study of infants born to mothers with anti-Ro autoantibodies. J Pediatr 2003; 142:678.
  8. Costedoat-Chalumeau N, Amoura Z, Lupoglazoff JM, et al. Outcome of pregnancies in patients with anti-SSA/Ro antibodies: a study of 165 pregnancies, with special focus on electrocardiographic variations in the children and comparison with a control group. Arthritis Rheum 2004; 50:3187.
  9. Friedman DM, Kim MY, Copel JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation 2008; 117:485.
  10. Michaëlsson M, Engle MA. Congenital complete heart block: an international study of the natural history. Cardiovasc Clin 1972; 4:85.
  11. Buyon JP, Winchester RJ, Slade SG, et al. Identification of mothers at risk for congenital heart block and other neonatal lupus syndromes in their children. Comparison of enzyme-linked immunosorbent assay and immunoblot for measurement of anti-SS-A/Ro and anti-SS-B/La antibodies. Arthritis Rheum 1993; 36:1263.
  12. Stea EA, Routsias JG, Clancy RM, et al. Anti-La/SSB antiidiotypic antibodies in maternal serum: a marker of low risk for neonatal lupus in an offspring. Arthritis Rheum 2006; 54:2228.
  13. Llanos C, Izmirly PM, Katholi M, et al. Recurrence rates of cardiac manifestations associated with neonatal lupus and maternal/fetal risk factors. Arthritis Rheum 2009; 60:3091.
  14. Izmirly PM, Llanos C, Lee LA, et al. Cutaneous manifestations of neonatal lupus and risk of subsequent congenital heart block. Arthritis Rheum 2010; 62:1153.
  15. Buyon J, Roubey R, Swersky S, et al. Complete congenital heart block: risk of occurrence and therapeutic approach to prevention. J Rheumatol 1988; 15:1104.
  16. Gordon P, Khamashta MA, Rosenthal E, et al. Anti-52 kDa Ro, anti-60 kDa Ro, and anti-La antibody profiles in neonatal lupus. J Rheumatol 2004; 31:2480.
  17. Jaeggi E, Laskin C, Hamilton R, et al. The importance of the level of maternal anti-Ro/SSA antibodies as a prognostic marker of the development of cardiac neonatal lupus erythematosus a prospective study of 186 antibody-exposed fetuses and infants. J Am Coll Cardiol 2010; 55:2778.
  18. Silverman ED, Buyon J, Laxer RM, et al. Autoantibody response to the Ro/La particle may predict outcome in neonatal lupus erythematosus. Clin Exp Immunol 1995; 100:499.
  19. Salomonsson S, Dörner T, Theander E, et al. A serologic marker for fetal risk of congenital heart block. Arthritis Rheum 2002; 46:1233.
  20. Salomonsson S, Sonesson SE, Ottosson L, et al. Ro/SSA autoantibodies directly bind cardiomyocytes, disturb calcium homeostasis, and mediate congenital heart block. J Exp Med 2005; 201:11.
  21. Clancy RM, Buyon JP, Ikeda K, et al. Maternal antibody responses to the 52-kd SSA/RO p200 peptide and the development of fetal conduction defects. Arthritis Rheum 2005; 52:3079.
  22. Strandberg L, Winqvist O, Sonesson SE, et al. Antibodies to amino acid 200-239 (p200) of Ro52 as serological markers for the risk of developing congenital heart block. Clin Exp Immunol 2008; 154:30.
  23. Ho SY, Esscher E, Anderson RH, Michaëlsson M. Anatomy of congenital complete heart block and relation to maternal anti-Ro antibodies. Am J Cardiol 1986; 58:291.
  24. Alexander E, Buyon JP, Provost TT, Guarnieri T. Anti-Ro/SS-A antibodies in the pathophysiology of congenital heart block in neonatal lupus syndrome, an experimental model. In vitro electrophysiologic and immunocytochemical studies. Arthritis Rheum 1992; 35:176.
  25. Neufing PJ, Clancy RM, Jackson MW, et al. Exposure and binding of selected immunodominant La/SSB epitopes on human apoptotic cells. Arthritis Rheum 2005; 52:3934.
  26. Clancy RM, Neufing PJ, Zheng P, et al. Impaired clearance of apoptotic cardiocytes is linked to anti-SSA/Ro and -SSB/La antibodies in the pathogenesis of congenital heart block. J Clin Invest 2006; 116:2413.
  27. Miranda-Carús ME, Askanase AD, Clancy RM, et al. Anti-SSA/Ro and anti-SSB/La autoantibodies bind the surface of apoptotic fetal cardiocytes and promote secretion of TNF-alpha by macrophages. J Immunol 2000; 165:5345.
  28. Clancy R, Molad Y, Kapur R, et al. Histologic evidence supports apoptosis, IgG deposition, and novel macrophage/fibroblast crosstalk in the pathogenesis of congenital heart block (abstract). Arthritis Rheum 2002; 46:S394.
  29. Clancy RM, Askanase AD, Kapur RP, et al. Transdifferentiation of cardiac fibroblasts, a fetal factor in anti-SSA/Ro-SSB/La antibody-mediated congenital heart block. J Immunol 2002; 169:2156.
  30. Garcia S, Nascimento JH, Bonfa E, et al. Cellular mechanism of the conduction abnormalities induced by serum from anti-Ro/SSA-positive patients in rabbit hearts. J Clin Invest 1994; 93:718.
  31. Xiao GQ, Hu K, Boutjdir M. Direct inhibition of expressed cardiac l- and t-type calcium channels by igg from mothers whose children have congenital heart block. Circulation 2001; 103:1599.
  32. Karnabi E, Qu Y, Mancarella S, Boutjdir M. Rescue and worsening of congenital heart block-associated electrocardiographic abnormalities in two transgenic mice. J Cardiovasc Electrophysiol 2011; 22:922.
  33. Marger L, Mesirca P, Alig J, et al. Functional roles of Ca(v)1.3, Ca(v)3.1 and HCN channels in automaticity of mouse atrioventricular cells: insights into the atrioventricular pacemaker mechanism. Channels (Austin) 2011; 5:251.
  34. Strandberg LS, Cui X, Rath A, et al. Congenital heart block maternal sera autoantibodies target an extracellular epitope on the α1G T-type calcium channel in human fetal hearts. PLoS One 2013; 8:e72668.
  35. Provost TT, Watson R, Gammon WR, et al. The neonatal lupus syndrome associated with U1RNP (nRNP) antibodies. N Engl J Med 1987; 316:1135.
  36. Sheth AP, Esterly NB, Ratoosh SL, et al. U1RNP positive neonatal lupus erythematosus: association with anti-La antibodies? Br J Dermatol 1995; 132:520.
  37. Acherman RJ, Friedman DM, Buyon JP, et al. Doppler fetal mechanical PR interval prolongation with positive maternal anti-RNP but negative SSA/Ro and SSB/La auto-antibodies. Prenat Diagn 2010; 30:797.
  38. Sirén MK, Julkunen H, Kaaja R, et al. Role of HLA in congenital heart block: susceptibility alleles in children. Lupus 1999; 8:60.
  39. Clancy RM, Marion MC, Kaufman KM, et al. Identification of candidate loci at 6p21 and 21q22 in a genome-wide association study of cardiac manifestations of neonatal lupus. Arthritis Rheum 2010; 62:3415.
  40. Clancy RM, Backer CB, Yin X, et al. Genetic association of cutaneous neonatal lupus with HLA class II and tumor necrosis factor alpha: implications for pathogenesis. Arthritis Rheum 2004; 50:2598.
  41. Meisgen S, Östberg T, Salomonsson S, et al. The HLA locus contains novel foetal susceptibility alleles for congenital heart block with significant paternal influence. J Intern Med 2014; 275:640.
  42. Stevens AM, Hermes HM, Rutledge JC, et al. Myocardial-tissue-specific phenotype of maternal microchimerism in neonatal lupus congenital heart block. Lancet 2003; 362:1617.
  43. Silverman E, Jaeggi E. Non-cardiac manifestations of neonatal lupus erythematosus. Scand J Immunol 2010; 72:223.
  44. Neiman AR, Lee LA, Weston WL, Buyon JP. Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry. J Pediatr 2000; 137:674.
  45. Lee LA. Neonatal lupus: clinical features, therapy, and pathogenesis. Curr Rheumatol Rep 2001; 3:391.
  46. Peñate Y, Guillermo N, Rodríguez J, et al. Histopathologic characteristics of neonatal cutaneous lupus erythematosus: description of five cases and literature review. J Cutan Pathol 2009; 36:660.
  47. Jaeggi ET, Hamilton RM, Silverman ED, et al. Outcome of children with fetal, neonatal or childhood diagnosis of isolated congenital atrioventricular block. A single institution's experience of 30 years. J Am Coll Cardiol 2002; 39:130.
  48. Johansen AS, Herlin T. [Neonatal lupus syndrome. Association with complete congenital atrioventricular block]. Ugeskr Laeger 1998; 160:2521.
  49. Askanase AD, Friedman DM, Copel J, et al. Spectrum and progression of conduction abnormalities in infants born to mothers with anti-SSA/Ro-SSB/La antibodies. Lupus 2002; 11:145.
  50. Buyon JP, Hiebert R, Copel J, et al. Autoimmune-associated congenital heart block: demographics, mortality, morbidity and recurrence rates obtained from a national neonatal lupus registry. J Am Coll Cardiol 1998; 31:1658.
  51. Waltuck J, Buyon JP. Autoantibody-associated congenital heart block: outcome in mothers and children. Ann Intern Med 1994; 120:544.
  52. Jaeggi ET, Silverman ED, Laskin C, et al. Prolongation of the atrioventricular conduction in fetuses exposed to maternal anti-Ro/SSA and anti-La/SSB antibodies did not predict progressive heart block. A prospective observational study on the effects of maternal antibodies on 165 fetuses. J Am Coll Cardiol 2011; 57:1487.
  53. Chockalingam P, Jaeggi ET, Rammeloo LA, et al. Persistent fetal sinus bradycardia associated with maternal anti-SSA/Ro and anti-SSB/La antibodies. J Rheumatol 2011; 38:2682.
  54. Brucato A, Previtali E, Ramoni V, Ghidoni S. Arrhythmias presenting in neonatal lupus. Scand J Immunol 2010; 72:198.
  55. Hornberger LK, Al Rajaa N. Spectrum of cardiac involvement in neonatal lupus. Scand J Immunol 2010; 72:189.
  56. Cuneo BF, Strasburger JF, Niksch A, et al. An expanded phenotype of maternal SSA/SSB antibody-associated fetal cardiac disease. J Matern Fetal Neonatal Med 2009; 22:233.
  57. Moak JP, Barron KS, Hougen TJ, et al. Congenital heart block: development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol 2001; 37:238.
  58. Cimaz R, Stramba-Badiale M, Brucato A, et al. QT interval prolongation in asymptomatic anti-SSA/Ro-positive infants without congenital heart block. Arthritis Rheum 2000; 43:1049.
  59. Falcini F, De Simone L, Donzelli G, Cerinic MM. Congenital conduction defects in children born to asymptomatic mothers with anti-SSA/SSB antibodies: report of two cases. Ann Ital Med Int 1998; 13:169.
  60. Houssiau FA, Lebacq EG. Neonatal lupus erythematosus with congenital heart block associated with maternal systemic lupus erythematosus. Clin Rheumatol 1986; 5:505.
  61. Fu LS, Hwang B, Lee BH. Newborns of Chinese mother with systemic lupus erythematosus (SLE). Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1992; 33:341.
  62. Nield LE, Silverman ED, Taylor GP, et al. Maternal anti-Ro and anti-La antibody-associated endocardial fibroelastosis. Circulation 2002; 105:843.
  63. Nield LE, Silverman ED, Smallhorn JF, et al. Endocardial fibroelastosis associated with maternal anti-Ro and anti-La antibodies in the absence of atrioventricular block. J Am Coll Cardiol 2002; 40:796.
  64. Guettrot-Imbert G, Cohen L, Fermont L, et al. A new presentation of neonatal lupus: 5 cases of isolated mild endocardial fibroelastosis associated with maternal Anti-SSA/Ro and Anti-SSB/La antibodies. J Rheumatol 2011; 38:378.
  65. Ferrazzini G, Fasnacht M, Arbenz U, et al. Neonatal lupus erythematosus with congenital heart block and severe heart failure due to myocarditis and endocardititis of the mitral valve. Intensive Care Med 1996; 22:464.
  66. Kim KR, Yoon TY. A case of neonatal lupus erythematosus showing transient anemia and hepatitis. Ann Dermatol 2009; 21:315.
  67. Lynn Cheng C, Galbraith S, Holland K. Congenital lupus erythematosus presenting at birth with widespread erosions, pancytopenia, and subsequent hepatobiliary disease. Pediatr Dermatol 2010; 27:109.
  68. Lee LA, Sokol RJ, Buyon JP. Hepatobiliary disease in neonatal lupus: prevalence and clinical characteristics in cases enrolled in a national registry. Pediatrics 2002; 109:E11.
  69. Yuan TM, Chen LH, Yu HM. Neonatal lupus erythematosus: three case reports and review of the Chinese literature. Clin Pediatr (Phila) 2010; 49:627.
  70. Wolach B, Choc L, Pomeranz A, et al. Aplastic anemia in neonatal lupus erythematosus. Am J Dis Child 1993; 147:941.
  71. Boros CA, Spence D, Blaser S, Silverman ED. Hydrocephalus and macrocephaly: new manifestations of neonatal lupus erythematosus. Arthritis Rheum 2007; 57:261.
  72. Askanase AD, Izmirly PM, Katholi M, et al. Frequency of neuro-psychiatric dysfunction in anti-SSA/SSB exposed children with and without neonatal lupus. Lupus 2010; 19:300.
  73. Chen CC, Lin KL, Chen CL, et al. Central nervous system manifestations of neonatal lupus: a systematic review. Lupus 2013; 22:1484.
  74. Glickstein JS, Buyon J, Friedman D. Pulsed Doppler echocardiographic assessment of the fetal PR interval. Am J Cardiol 2000; 86:236.
  75. Zhao H, Cuneo BF, Strasburger JF, et al. Electrophysiological characteristics of fetal atrioventricular block. J Am Coll Cardiol 2008; 51:77.
  76. Gardiner HM, Belmar C, Pasquini L, et al. Fetal ECG: a novel predictor of atrioventricular block in anti-Ro positive pregnancies. Heart 2007; 93:1454.
  77. Askanase A, Friedman D, Glickstein J, et al. Potential therapeutic window from normal heart rate (NHR) to advanced heart block and early detection of first degree block by echocardiographic measurement of the mechanical PR interval. Arthritis Rheum 2002; 46:S321 (Abstract).
  78. Vesel S, Mazić U, Blejec T, Podnar T. First-degree heart block in the fetus of an anti-SSA/Ro-positive mother: reversal after a short course of dexamethasone treatment. Arthritis Rheum 2004; 50:2223.
  79. Sonesson SE, Salomonsson S, Jacobsson LA, et al. Signs of first-degree heart block occur in one-third of fetuses of pregnant women with anti-SSA/Ro 52-kd antibodies. Arthritis Rheum 2004; 50:1253.
  80. Buyon JP, Askanase AD, Kim MY, et al. Identifying an early marker for congenital heart block: when is a long PR interval too long? Comment on the article by Sonesson et al. Arthritis Rheum 2005; 52:1341.
  81. Bergman G, Skog A, Tingström J, et al. Late development of complete atrioventricular block may be immune mediated and congenital in origin. Acta Paediatr 2014; 103:275.
  82. Silverman ED. Neonatal lupus. In: Textbook of pediatric rheumatology, Cassidy JT, Petty RE (Eds), WB Saunders, Philadelphia 2001. p.456.
  83. Simell O, Perheentupa J, Rapola J, et al. Lysinuric protein intolerance. Am J Med 1975; 59:229.
  84. Palacín M, Borsani G, Sebastio G. The molecular bases of cystinuria and lysinuric protein intolerance. Curr Opin Genet Dev 2001; 11:328.
  85. Saleeb S, Copel J, Friedman D, Buyon JP. Comparison of treatment with fluorinated glucocorticoids to the natural history of autoantibody-associated congenital heart block: retrospective review of the research registry for neonatal lupus. Arthritis Rheum 1999; 42:2335.
  86. Yamada H, Kato EH, Ebina Y, et al. Fetal treatment of congenital heart block ascribed to anti-SSA antibody: case reports with observation of cardiohemodynamics and review of the literature. Am J Reprod Immunol 1999; 42:226.
  87. Friedman DM, Kim MY, Copel JA, et al. Prospective evaluation of fetuses with autoimmune-associated congenital heart block followed in the PR Interval and Dexamethasone Evaluation (PRIDE) Study. Am J Cardiol 2009; 103:1102.
  88. Rein AJ, Mevorach D, Perles Z, et al. Early diagnosis and treatment of atrioventricular block in the fetus exposed to maternal anti-SSA/Ro-SSB/La antibodies: a prospective, observational, fetal kinetocardiogram-based study. Circulation 2009; 119:1867.
  89. Jaeggi ET, Fouron JC, Silverman ED, et al. Transplacental fetal treatment improves the outcome of prenatally diagnosed complete atrioventricular block without structural heart disease. Circulation 2004; 110:1542.
  90. Breur JM, Visser GH, Kruize AA, et al. Treatment of fetal heart block with maternal steroid therapy: case report and review of the literature. Ultrasound Obstet Gynecol 2004; 24:467.
  91. Hutter D, Silverman ED, Jaeggi ET. The benefits of transplacental treatment of isolated congenital complete heart block associated with maternal anti-Ro/SSA antibodies: a review. Scand J Immunol 2010; 72:235.
  92. Mevorach D, Elchalal U, Rein AJ. Prevention of complete heart block in children of mothers with anti-SSA/Ro and anti-SSB/La autoantibodies: detection and treatment of first-degree atrioventricular block. Curr Opin Rheumatol 2009; 21:478.
  93. Trucco SM, Jaeggi E, Cuneo B, et al. Use of intravenous gamma globulin and corticosteroids in the treatment of maternal autoantibody-mediated cardiomyopathy. J Am Coll Cardiol 2011; 57:715.
  94. Friedman DM, Llanos C, Izmirly PM, et al. Evaluation of fetuses in a study of intravenous immunoglobulin as preventive therapy for congenital heart block: Results of a multicenter, prospective, open-label clinical trial. Arthritis Rheum 2010; 62:1138.
  95. Pisoni CN, Brucato A, Ruffatti A, et al. Failure of intravenous immunoglobulin to prevent congenital heart block: Findings of a multicenter, prospective, observational study. Arthritis Rheum 2010; 62:1147.
  96. Izmirly PM, Kim MY, Llanos C, et al. Evaluation of the risk of anti-SSA/Ro-SSB/La antibody-associated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposed to hydroxychloroquine. Ann Rheum Dis 2010; 69:1827.
  97. Izmirly PM, Costedoat-Chalumeau N, Pisoni CN, et al. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation 2012; 126:76.
  98. Lawrence S, Luy L, Laxer R, et al. The health of mothers of children with cutaneous neonatal lupus erythematosus differs from that of mothers of children with congenital heart block. Am J Med 2000; 108:705.
  99. Costedoat-Chalumeau N, Amoura Z, Le Thi Hong D, et al. Questions about dexamethasone use for the prevention of anti-SSA related congenital heart block. Ann Rheum Dis 2003; 62:1010.
  100. Klauninger R, Skog A, Horvath L, et al. Serologic follow-up of children born to mothers with Ro/SSA autoantibodies. Lupus 2009; 18:792.
  101. Bergman G, Eliasson H, Mohlkert LA, et al. Progression to first-degree heart block in preschool children exposed in utero to maternal anti-SSA/Ro52 autoantibodies. Acta Paediatr 2012; 101:488.
  102. Izmirly PM, Saxena A, Kim MY, et al. Maternal and fetal factors associated with mortality and morbidity in a multi-racial/ethnic registry of anti-SSA/Ro-associated cardiac neonatal lupus. Circulation 2011; 124:1927.
  103. Eliasson H, Sonesson SE, Sharland G, et al. Isolated atrioventricular block in the fetus: a retrospective, multinational, multicenter study of 175 patients. Circulation 2011; 124:1919.
  104. Martin V, Lee LA, Askanase AD, et al. Long-term followup of children with neonatal lupus and their unaffected siblings. Arthritis Rheum 2002; 46:2377.
  105. Spence D, Hornberger L, Hamilton R, Silverman ED. Increased risk of complete congenital heart block in infants born to women with hypothyroidism and anti-Ro and/or anti-La antibodies. J Rheumatol 2006; 33:167.
  106. Askanase AD, Iloh I, Buyon JP. Hypothyroidism and antithyroglobulin and antithyroperoxidase antibodies in the pathogenesis of autoimmune associated congenital heart block. J Rheumatol 2006; 33:2099.