Neonatal Cardiac Function in Offspring Born to Mothers with Systemic Lupus Erythematosus: Insights from the Legacy Cohort

Objectives Systemic lupus erythematosus (SLE) increases the risk of placenta-mediated adverse pregnancy outcomes (APO) and may impact offspring cardiovascular health. Transplacental maternal anti-Ro antibodies can affect fetal cardiac function. Speckle tracking echocardiography (STE), a sensitive tool for detecting early cardiac dysfunction, remains underused in neonates. We used STE to assess the influence of maternal anti-Ro antibodies and APO on neonatal myocardial strain. Methods Participants were recruited from the Montreal site of the Lupus in prEGnAnCY (LEGACY) cohort, a multicenter prospective cohort enrolling SLE pregnancies at < 17 gestational weeks. APO was evaluated at each trimester and postpartum, and included: 1) gestational hypertension, preeclampsia and/or eclampsia, 2) placental insufficiency, 3) placental abruption, and/or 4) small for gestational age (SGA ≤ 5 percentile). Neonatal cardiac function was assessed ≤4 weeks postpartum using STE, with global longitudinal strain (GLS) reported via apical endocardial or apical 4-chamber peak longitudinal strain. GLS is expressed as a negative percentage, with more negative values indicating better myocardial contractile function. We evaluated GLS with univariable and multivariable regression analysis adjusting for neonatal age and birth weight. Results This study included 26 pregnant women with SLE, of mean maternal age 35.9± 4.7 years and disease duration 9.9 ± 7.4 years. Most were in Lupus Low Disease Activity State (LLDAS) at baseline (85%), and 65% (15/26) maintained LLDAS throughout pregnancy. Live birth occurred in 89% (23/26), among which APO occurred in 42% (11/26). Out of live births, 3 missed the STE assessment and 4 had suboptimal images preventing GLS estimation. Thus, GLS was assessed in 16 neonates of mean age 11.8 ± 26.2 days at STE (Table 1). HCQ was used by all mothers (16/16), with mean cumulative gestational exposure of 1103.2 ± 294.6 mg x days/kg. Mean GLS was-26.3 ± 4.2%, with term neonates at −26.2 ± 4.3%. Lower mean GLS was observed in neonates born to mothers with APO (−25.2 ± 4.3%) and anti-Ro antibodies (−24.8 ± 4.5) vs their respective counterparts (−27.2 ± 4.1% and −27.9 ± 3.4%). GLS was not significantly associated with APO, or anti-Ro positivity in multivariable models. Table 1. Maternal and neonatal characteristics of mother–newborn dyads with neonatal GLS assessments, stratified by anti-Ro antibodies status Conclusion We observed lower GLS in neonates born to SLE mothers with anti-Ro antibodies and those with APO. Though not statistically significant, potentially due to small sample size, the trends may reflect subclinical cardiac alterations. These findings support the need for larger studies to clarify the impact of maternal antibodies, APO, and HCQ on fetal cardiac health.