Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: A prospective study of 100 women

Brucato, Antonio; Frassi, Micol; Franceschini, Franco; Cimaz, Rolando; Faden, D; Pisoni, Maria Pia; Muscarà, Marina; Vignati, Gabriele; Stramba-Badiale, Marco; Catelli, Luca; Lojacono, Andrea; Cavazzana, Ilaria; Ghirardello, Anna; Vescovi, F.; Gambari, P F; Doria, Andrea; Meroni, Pier Luigi; Tincani, Anǵela

doi:10.1002/1529-0131(200108)44:8<1832::aid-art320>3.0.co;2-c

Cited by 438 publications

(264 citation statements)

References 13 publications

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“…An erythematous skin rash with a predilection for the scalp and periorbital region, most often apparent in the first 8 weeks after birth, is also linked strongly to these maternal antibodies and to antibodies against U1 ribonucleic protein [24]. Maternal anti-Ro and anti-La antibodies may cause congenital heart block in 2% of babies [25]. Congenital heart block occurs between 18 and 30 weeks gestation, and fetal echocardiography should be performed during this period to facilitate early detection.…”

Section: Discussionmentioning

confidence: 99%

The correlation of pregnancy complications with C3/C4 levels, anti-dsDNA titers, and autoimmune target testing in gravidas with systemic lupus erythematosus

Kim¹,

Kim

Kang

et al. 2011

Korean J Obstet Gynecol

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ObjectiveThe purpose of this study was to evaluate the correlation between complement (C3 and C4) levels, anti-dsDNA titers, autoimmune target test (AITT), and pregnancy complications. MethodsNinety-three pregnancies with systemic lupus erythematosus (SLE) were analyzed retrospectively. We evaluated the course of the pregnancy and outcome, pregnancy complications, progression of SLE, maternal complications of SLE, drugs taken before and after pregnancy, neonatal outcomes, and C3/C4 levels, anti-dsDNA titers, and AITT results. SPSS ver. 14.0 was used for statistical analysis. The average and standard deviation are shown. Chi-square test and Pearson correlation test were used for statistical analysis. The significance level was set at 0.05. ResultsThe C3 level was associated with maternal leukopenia, elevated serum C-reactive protein (CRP) elevation, hematuria, hypertension, and preterm premature rupture of membranes. The C4 level was associated with maternal proteinuria, hematuria, hematologic disease, and admission to the neonatal intensive care unit. The anti-dsDNA titer was associated with elevated maternal serum CRP, oligohydramnios, and neonatal anti-Sjögren's syndrome B (La) antibody. The AITT result was related to elevated erythrocyte sedimentation rate, and 1 and 5 minute Apgar scores. ConclusionOur result show that adding the AITT to conventional C3/C4 and anti-dsDNA testing in gravidas with SLE might help antenatal care.

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Section: Discussionmentioning

confidence: 99%

The correlation of pregnancy complications with C3/C4 levels, anti-dsDNA titers, and autoimmune target testing in gravidas with systemic lupus erythematosus

Kim¹,

Kim

Kang

et al. 2011

Korean J Obstet Gynecol

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“…Long-term effects of lupus in the offspring of SLE women are rare but include congenital heart block which can ultimately lead to the implantation of a definite pacemaker [19][20][21][22][23]. Positive SSa/SSbs are surrogates to this complication and all SLE patients should be screened for its presence.…”

Section: Discussionmentioning

confidence: 99%

Lupus and Pregnancy—15 Years of Experience in a Tertiary Center

Ambrósio¹,

Lermann²,

Cordeiro³

et al. 2009

Clinic Rev Allerg Immunol

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This retrospective study was designed to evaluate the outcome of pregnancies in women diagnosed with systemic lupus erythematosus (SLE) followed in a tertiary fetal-maternal center. Data were collected from clinical charts between January 1993 and December 2007, with a total of 136 pregnancies (107 patients). Mean maternal age was 29 years, with the vast majority of patients being Caucasian. Most patients were in remission 6 months prior to pregnancy (93%) and the most frequently affected organs were the skin and joints. Renal lupus accounted for 14% of all cases. Twenty-nine percent of patients were positive for at least one antiphospholid antibody (aPL) and nearly 50% had positive SSa/SSb antibodies. All patients with positive aPL received low-dosage aspirin and lowmolecular-weight heparin (LMWH). There were no pregnancy complications in more than 50% of cases and hypertensive disease and intrauterine growth restriction were the most common adverse events. There were 125 live births, one neonatal death, eight miscarriages, and three medical terminations of pregnancy. Preterm delivery occurred in 25% of pregnancies. Our results are probably the conjoined result of a multidisciplinary approach together with a systematic management of SLE pregnancies, with most patients keeping their prior SLE medication combined with low-dosage aspirin and LMWH in the presence of aPL.

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“…Congenital complete heart block, diagnosed by mid-trimester fetal echocardiography, was detected in 2% of first-observed pregnancies and 1.8 % of live births to women with positive maternal screening for anti-SSA/Ro antibodies [2][3][4]. In a prospective study of 98 infants born to mothers with positive anti-SSA/Ro antibodies, three infants had first degree block, three had third degree block, and four had cutaneous neonatal lupus [5].…”

Section: Epidemiologymentioning

confidence: 99%

Neonatal Lupus Erythematosus

Nasef

Hafez²,

Bakr³

2014

NCP

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Neonatal lupus is a passively acquired autoimmune disease that occurs in offspring of mothers with anti-SSA/Ro and/or anti-SSB/La antibodies. The primary clinical features are a photosensitive rash that is usually found on the scalp and periorbital areas, congenital heart block with or without cardiomyopathy, cytopenias, disseminated intravascular coagulation, and neonatal cholestasis with or without elevated transaminases. The diagnosis is usually made in utero by detection of a slow fetal heart rate and subsequent fetal echocardiographic confirmation of heart block and/or cardiomyopathy. Prenatal treatment with fluorinated glucocorticoids beginning as soon after detection has favourable outcome for mothers of fetuses with second degree heart block, is of no value for mothers of fetuses with third degree heart block, and controversial for mothers of fetuses with first degree heart block. Prenatal glucocorticoids can be used also in presence of cardiomyopathy associated with neonatal lupus. Hydroxychloroquine has been used in pregnant women who have anti-SSA/Ro antibodies and who have previously given birth to a child with cardiac manifestations. First and second degree block, detected in utero or at birth, can progress to complete heart block. Infants with complete heart block usually require a pacemaker with an excellent prognosis, although development of heart failure may occur.

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Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: A prospective study of 100 women

Cited by 438 publications

References 13 publications

The correlation of pregnancy complications with C3/C4 levels, anti-dsDNA titers, and autoimmune target testing in gravidas with systemic lupus erythematosus

The correlation of pregnancy complications with C3/C4 levels, anti-dsDNA titers, and autoimmune target testing in gravidas with systemic lupus erythematosus

Lupus and Pregnancy—15 Years of Experience in a Tertiary Center

Neonatal Lupus Erythematosus

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