Paediatrics: Maternal disorders causing neonatal disease

Maternal disorders causing neonatal disease

Any maternal disease can adversely affect foetal and neonatal health. Certain maternal illnesses, e.g. CHD, also raise the risk of inheritance in the newborn. Most common manifestations are:

·  Spontaneous abortion.

·  Foetal death.

·  IUGR and/or preterm delivery.

Maternal drug ingestion

Maternal medications or substance abuse can affect the newborn:

·  maternal anticonvulsants;

·  alcohol abuse and foetal alcohol syndrome;

·  tobacco;

·  neonatal abstinence syndrome.

Hypertensive diseases

Pregnancy-induced hypertension (e.g. pre-eclampsia, eclampsia, haemolyt-ic anaemia–elevated liver enzymes–low platelet count (HELLP) syndrome) is associated with increased foetal loss, the need for preterm delivery, IUGR, neonatal leucopenia, and thrombocytopenia. Maternal drug treat-ment may cause neonatal hypoglycaemia and hypotension.

Systemic lupus erythematosus

Associated with:

·  Rise -  Risk of spontaneous abortion.

·  IUGR.

·  Preterm delivery.

·  Neonatal lupus syndrome (rare; associated with anti-Ro and –La antibodies): complete heart block, haemolytic anaemia, leucopenia, thrombocytopenia, and discoid erythematous skin rash.

Antiphospholipid syndrome 

Maternal antiphospholipid antibodies (e.g. lupus anticoagulant or anticardiolipin antibodies) are associated with spontaneous abortion, IUGR, foetal death, need for preterm delivery.

Thyroid disease

In 710% of women with Graves’s disease, thyroid-stimulating hormone (TSH) receptor-stimulator antibodies cross the placenta causing neonatal thyrotoxicosis. Foetus most likely to be affected if high maternal IgG se-rum level develops, or mother requires treatment during pregnancy. Take cord blood for TSH, fT4, and TSH receptor antibody (TRAB). Repeat at D5 if results abnormal.

Myasthenia gravis

In 710% transplacental passage of IgG antibodies to motor end-plate ace-tylcholine receptors causes transient neonatal myasthenia gravis.