Maternal SLE Influence in Fetal Development: Immune and Endocrine Systems

Pregnancy markedly alters the normal physiology of the women and immune response mechanisms. During normal pregnancy the immune system is reinforced to maintain the well-being of the mother and fetus by modifying the manner that a mother responds to the environment, in such a way that recognition, communication, trafficking and repair mechanisms are all uniformly regulated. In spite of the fact that the fetus could be considered a stranger to the mother ́s immune system, maternal tolerance develops; the latter could be the result of the integration of numerous mechanisms promoted by different cells present in the decidua. Autoimmunity even in the absence of clinically manifest autoimmune disease can affect each event of pregnancy and can induce fetal and maternal complications as well as adverse outcomes. The effect pregnancy has on the course of systemic lupus erythematosus (SLE) remains speculative. Elevated levels of auto-antibodies are frequently are associated with lost pregnancy, as they can cross placental barrier and make contact with blood vessels. Fetal endothelial cells make the first encounter with maternal cells or molecules that cross the placental barrier and this initial contact induces some primary regulation on endothelial cell activity thereby modifying inflammatory response or vascular tone, amongst others. If maternal antibodies cross the placental barrier, this could induce the expression of proinflammatory molecules, such as TNF-alpha, IL-6 or IL-8 (Yazici et al., 2001), by endothelial cells or could induce the formation of immune complexes that can cause fetal damage. Pregnant lupus patients are susceptible to preeclampsia, especially if they suffer lupus nephritis, and also to steroid-induced hypertension and hyperglycemia. At the same time fetuses are susceptible to placental insufficiency if antiphospholipid antibodies or other procoagulant states are present, and to neonatal lupus in the presence of anti-Ro/La antibodies (Lockshin & Sammaritano, 2003). The study of the physiology and immunology of pregnancy in SLE mothers may enhance our understanding of SLE and the possible consequences on the child development and quality of life.