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Obstetrics
Maternal autoantibody levels in congenital heart block and potential prophylaxis with antiinflammatory agents

Presented as an abstract at the 61st Annual Scientific Session of the American College of Cardiology, Chicago, IL, March 23-27, 2012.
https://doi.org/10.1016/j.ajog.2012.09.020Get rights and content

Objective

The importance of maternal autoantibody levels in congenital heart block and elucidation of maternal factors that may reduce disease burden require further clarification.

Study Design

Pregnancies complicated by maternal anti-Ro antibodies from 2007 through 2011 were retrospectively reviewed.

Results

In all, 33 women were followed up throughout pregnancy. Semiquantitative maternal anti-La levels were significantly higher in pregnancies complicated by fetal heart block of any degree (median difference, 227.5; P = .04), but there was no difference in maternal anti-Ro levels. In all, 94% of fetuses maintained normal conduction when the mother was treated with hydroxychloroquine or daily prednisone therapy throughout pregnancy, compared to 59% in the untreated group (odds ratio, 0.1; P = .04).

Conclusion

Pregnancies complicated by fetal heart block did not have higher levels of maternal anti-Ro antibodies. Maternal anti-La level may be a useful predictor of fetal heart block. Maternal treatment with either hydroxychloroquine or daily low-dose prednisone throughout pregnancy may provide a protective effect.

Section snippets

Materials and Methods

This study was approved by the Duke University Hospital Institutional Review Board. Subjects were identified by reviewing the outpatient schedule and records from our fetal cardiology clinic and affiliated community pediatric cardiology clinics from 2007 through 2011. Records from our rheumatology and maternal-fetal medicine clinics were also reviewed for supplemental information. All pregnant women who were positive for anti-Ro/SSA antibodies and serially screened via fetal echocardiography

Results

In all, 33 subjects were followed up at our institution during the study period. Maternal information is summarized in Table 1. Average subject age was 29.2 years. In all, 61% (n = 20) had a diagnosis of systemic lupus erythematosus. Other rheumatologic diagnoses included unspecified rheumatologic disease (n = 8, 24%), Sjögren syndrome (n = 3, 9%), spondyloarthritis with associated Crohn's disease and autoimmune neutropenia (n = 1, 3%), and rheumatoid arthritis (n = 1, 3%). An average of 9

Comment

The results of this study suggest that maternal therapy with antiinflammatory agents throughout pregnancy may provide a protective effect against the development of congenital heart block. Once complete fetal heart block develops, it is irreversible and leads to significant morbidity and potential mortality for the infant.15, 16, 17 It has been demonstrated that the fetal rhythm can rapidly and dramatically change from normal AV conduction to complete heart block in a matter of days.18 The

Acknowledgments

We would like to thank Donna Bouser, analytical specialist in the immunology laboratory, for her assistance in obtaining maternal antibody level data. We also thank Robin Wilson, RN, and Tracy Fukes, RN, in the pediatric echo laboratory for their assistance in patient identification. No compensation was provided to these individuals for their efforts.

References (25)

  • S.E. Sonesson et al.

    Signs of first-degree heart block occur in one-third of fetuses of pregnant women with anti-SSA/Ro 52-kd antibodies

    Arthritis Rheum

    (2004)
  • D.M. Friedman et al.

    Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR interval and dexamethasone evaluation (PRIDE) prospective study

    Circulation

    (2008)
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    The authors report no conflict of interest.

    Cite this article as: Tunks RD, Clowse MEB, Miller SG, et al. Maternal autoantibody levels in congenital heart block and potential prophylaxis with antiinflammatory agents. Am J Obstet Gynecol 2013;208:64.e1-7.

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