Neonatal lupus — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateConnective Tissue DiseasesNeonatal lupusSCE Rheumatology

A 30-year-old pregnant woman with anti-Ro-positive Sjögren disease attends at 12 weeks' gestation. She previously had a child with transient neonatal rash. She is clinically well on hydroxychloroquine. She asks what fetal issue is most relevant to discuss and monitor. What is the most important complication to screen for?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Congenital heart block

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · B = shown as D · A = shown as E

Congenital heart block is best because maternal anti-Ro/La antibodies are associated with neonatal lupus, especially congenital heart block. B is less suitable because fetal renal agenesis is not the classic anti-Ro risk; C is less suitable because osteogenesis imperfecta is a genetic collagen disorder unrelated to anti-Ro antibodies; D is less suitable because placenta accreta is related to uterine scarring and placental factors; E is less suitable because hydroxychloroquine is pregnancy-compatible and not a neural tube defect drug. Clinical pearl: continuing hydroxychloroquine is commonly favoured in anti-Ro-positive rheumatic disease pregnancies.

Reference: BSR pregnancy and breastfeeding guideline 2022; BSR Sjögren disease guideline 2023