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Development of heart block in children of SSA/SSB-autoantibody-positive women is associated with maternal age and displays a season-of-birth pattern
  1. Aurélie Ambrosi1,
  2. Stina Salomonsson1,
  3. Håkan Eliasson2,
  4. Elisabeth Zeffer1,
  5. Amanda Skog1,
  6. Vijole Dzikaite1,
  7. Gunnar Bergman2,
  8. Eva Fernlund3,
  9. Joanna Tingström1,
  10. Elke Theander4,
  11. Annika Rydberg5,
  12. Thomas Skogh6,
  13. Annika Öhman7,
  14. Ulla Lundström8,
  15. Mats Mellander8,
  16. Ola Winqvist1,
  17. Michael Fored1,
  18. Anders Ekbom1,
  19. Lars Alfredsson9,
  20. Henrik Källberg9,
  21. Tomas Olsson10,
  22. Fredrik Gadler1,
  23. Anders Jonzon7,
  24. Ingrid Kockum10,
  25. Sven-Erik Sonesson2,
  26. Marie Wahren-Herlenius1
  1. 1Department of Medicine, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
  4. 4Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
  5. 5Department of Clinical Sciences, Paediatrics, Umeå University Hospital, Umeå, Sweden
  6. 6Rheumatology/AIR, Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
  7. 7Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
  8. 8Department of Women's and Children's Health, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
  9. 9Institute of Environmental Medicine, Stockholm, Sweden
  10. 10Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Marie Wahren-Herlenius, Rheumatology Unit, Department of Medicine, Karolinska Institutet, 17176 Stockholm, Sweden; marie.wahren{at}


Objective Congenital heart block may develop in the fetuses of Ro/SSA-positive and La/SSB-positive mothers. Recurrence rates of only 10–20% despite persisting maternal antibodies indicate that additional factors are critical for the establishment of heart block. The authors investigated the influence of other maternal and fetal factors on heart block development in a Swedish population-based cohort.

Methods The influence of fetal gender, maternal age, parity and time of birth on heart block development was analysed in 145 families, including Ro/La-positive (n=190) and Ro/La-negative (n=165) pregnancies.

Results There was a recurrence rate of 12.1% in Ro/La-positive women, and no recurrence in Ro/La-negative women. Fetal gender and parity did not influence the development of heart block in either group. Maternal age in Ro/La-positive pregnancies with a child affected by heart block was, however, significantly higher than in pregnancies resulting in babies without heart block (p<0.05).Seasonal timing of pregnancy influenced the outcome. Gestational susceptibility weeks 18–24 occurring during January–March correlated with a higher proportion of children with heart block and lower vitamin D levels during the same period in a representative sample of Swedish women and a corresponding higher proportion of children with heart block born in the summer (p<0.02). Maternal age or seasonal timing of pregnancy did not affect the outcome in Ro/La-negative pregnancies.

Conclusion This study identifies maternal age and seasonal timing of pregnancy as novel risk factors for heart block development in children of Ro/La-positive women. These observations may be useful for counselling when pregnancy is considered.

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  • AA and SS contributed equally (shared first authorship).

  • Funding Financial support for this study was obtained from KIRCNET (Karolinska Institutet Circulation and Respiratory Research Network), the Magn. Bergvalls Foundation, the Jerring Foundation, Stiftelsen Samariten, the Karolinska Institute, The Royal Swedish Academy of Sciences, the Swedish Research Council, the Göran Gustafsson Foundation, the Torsten and Ragnar Söderberg Foundation, the King Gustaf Vth 80-Year Foundation, the Swedish Foundation for Strategic Research, the Heart–Lung Foundation and the Swedish Rheumatism Association.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Regional ethical committee of Karolinska Institutet, Stockholm.

  • Provenance and peer review Not commissioned; externally peer reviewed.