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Am J Perinatol 2002; 19(2): 073-080
DOI: 10.1055/s-2002-23555
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Fetal Echocardiographic Screening of Pregnancies of Mothers with Anti-Ro and/or Anti-La Antibodies

Gordon Gladman1 , Earl D. Silverman2, 4 ,  Yuk-Law1 , Lily Luy2 , Christine Boutin1 , Carl Laskin3 , Jeffrey F. Smallhorn1
  • 1Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
  • 2Division of Rheumatology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
  • 3The Division of Rheumatology, The Toronto Hospital, Toronto, Canada
  • 4Department of Immunology, University of Toronto, Toronto, Canada
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Publication History

Publication Date:
02 April 2002 (online)

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ABSTRACT

The objectives of this study are to assess the incidence of congenital complete heart block (CCHB) in pregnant women who are anti-Ro and/or La positive. Between January, 1988 and July 1997, 118 pregnancies in 105 women were assessed by fetal echo at 18, 24, and 32 weeks' gestation. Of these 105, 96 had no history of a previous fetus with CCHB; 11(12 pregnancies) a history of a pregnancy with CCHB; and 4 a previous child with cutaneous neonatal lupus erythematosus (CNLE). The 102 pregnancies in 96 women with anti-Ro and/or anti-La antibodies and no history of a previous child with NLB, resulted in 100 live-births with no CCHB. There was 1 dilated cardiomyopathy at 6 months, 1 child with CCHB, and 1 with sclerosis of the endocardium. No case of CCHB was observed in 102 pregnancies without a previous history of CCHB. These results suggest that the risks of CCHB, without a prior history are low.

KEYWORD

Congenital heart block - anti-Ro antibodies - anti-LA antibodies

REFERENCES

  • 1 Buyon J P, Waltuck J, Caidwell K. Relationship between maternal and neonatal levels of antibodies to 48 kDa SSB(La), 52 kDa SSA(Ro), and 60 kDa SSA(Ro) in pregnancies complicated by congenital heart block.  J Rheumatol . 1994;  21 1943-1950
    PubMedGoogle Scholar
  • 2 Dorner T, Hiepe F, Goldner B, Apostoloff E. Investigations into Ro-specific antibody-associated congenital cardiac conduction defects.  Clin Invest . 1992;  70 492-496
    PubMedGoogle Scholar
  • 3 Hubscher O, Batista N, Rivero S. Isolated congenital complete heart block: longterm outcome of mothers, maternal antibody specificity and immunogenetic background.  J Rheumatol . 1995;  22 533-540
    PubMedGoogle Scholar
  • 4 Julkunen H, Kurki P, Kaaja R. Isolated congenital heart block: long-term outcome of mothers and characterization of the immune response to 55-AIRo and to SS-B/La.  Arthritis Rheum . 1993;  36 1588-1598
    PubMedGoogle Scholar
  • 5 McCreadie M, Celermajer J, Sholler G. A case control study of congenital heart block: association with maternal antibodies to Ro(SS-A) and La(SS-B).  Br J Rheumatol . 1990;  29 10-14
    PubMedGoogle Scholar
  • 6 Silverman B, Mamula M, Hardin J A, Laxer K. Importance of the immune response to the Ro/La particle in the development of congenital heart block and neonatal lupus erythematosus.  J Rheumatol . 1991;  18 120-124
    PubMedGoogle Scholar
  • 7 Waltuck J, Buyon J P. Autoantibody-associated congenital heart block: outcome in mothers and children.  Ann Intern Med . 1994;  120 544-551
    CrossrefPubMedGoogle Scholar
  • 8 Scott J S, Taylor P V. Congenital AV-block: role of anti-Ro and anti-La antibodies.  Springer Semin Immunopathol . 1989;  11 397-408
    PubMedGoogle Scholar
  • 9 Litsey S E, Noonan J A, O'Connor W N, Cottrill C M, Mitchell B. Maternal connective tissue disease and congenital heart block.  New Engl J Med . 1985;  12 98-100
    PubMedGoogle Scholar
  • 10 Press J, Uziel Y, Laxer R M, Luy L, Hamilton R M, Silverman B D. Long-term outcome of mothers of children with complete congenital heart block.  Am J Med . 1996;  100 328-332
    CrossrefPubMedGoogle Scholar
  • 11 Brucato A, Franceschini F, Gasparini M. Isolated congenital complete heart block: longterm outcome of mothers, maternal antibody specificity and immunogenetic background.  J Rheumatol . 1995;  22 533-540
    PubMedGoogle Scholar
  • 12 Lockshin M D, Bonfa B, Elkon K, Druzin M L. Neonatal lupus risk to newborns of mothers with systemic lupus erythematosus.  Arthritis Rheum . 1988;  1 697-701
    PubMedGoogle Scholar
  • 13 Ramsey-Goldman K, Hom D, Deng S. Anti-SSA antibodies and fetal outcome in maternal systemic lupus erythematosus.  Arthritis Rheum . 1986;  29 1269-1273
    CrossrefPubMedGoogle Scholar
  • 14 Fu L S, Hwang B, Lee B H. Newborns of Chinese mother with systemic lupus erythematosus (SLE).  Acta Paediatrica Sinica . 1992;  3 341-349
    PubMedGoogle Scholar
  • 15 Allan L D. for the Fetal Cardiology Working Party of the Association of European Pediatric Cardiologists. Research protocol for fetuses with complete heart block.  Ultrasound Obstet Gynecol . 1995;  5 349-352
    PubMedGoogle Scholar
  • 16 Isacovics B, Silverman E D. Limiting dilution analysis of Epstein-Barr virns infectable B cells secreting anti-RoISSA and anti-La/SSB antibodies in neonatal lupus erythematosus and systemic lupus erythematosus.  J Autoimmun . 1993;  6 481-494
    CrossrefPubMedGoogle Scholar
  • 17 Petri M, Allbritton J. Fetal outcome of lupus pregnancy: a retrospective case-control study of the Hopkins Lupus Cohort.  J Rheumatol . 1993;  20 650-656
    PubMedGoogle Scholar
  • 18 Taylor-Albert E, Reichlin M, Toews W H, Overholt E D, Lee L A. Delayed dilated cardiomyopathy as a manifestation of neonatal lupus: case reports, autoantibody analysis, and management.  Pediatrics . 1997;  99 733-735
    CrossrefPubMedGoogle Scholar
  • 19 Hogg G. Congenital acute lupus erythematosus associated with subendocardial fibroelastosis.  Am J Clin Pathol . 1957;  28 648-654
    PubMedGoogle Scholar
  • 20 Hull D, Binns B A, Joyce D. Congenital heart block and widespread fibrosis due to maternal lupus erythematosus.  Arch Dis Child . 1966;  41 688-690
    PubMedGoogle Scholar
  • 21 Ho Y S, Esscher E, Anderson R H, Michaelsson M. Anatomy of congenital complete heart block and relation to maternal anti-R6 antibodies.  Am J Cardiol . 1986;  58 291-294
    CrossrefPubMedGoogle Scholar
  • 22 Lev M, Silverman J, Fitzmaurice F, Paul M H, Cassels D E, Miller R A. Lack of connection between the atria and the more peripheral conduction system in congenital atrioventricular block.  Am J Cardiol . 1971;  27 481-490
    CrossrefPubMedGoogle Scholar
  • 23 Carter J B, Blieden L C, Edwards J E. Congenital heart block.  Arch Pathol . 1974;  97 51-57
    PubMedGoogle Scholar
  • 24 James T N. Cardiac conduction system: fetal and postnatal development.  Am J Cardiol . 1970;  25 213-226
    CrossrefPubMedGoogle Scholar
  • 25 Stephenson O, Cleland W P, Hallidie-Smith K. Congenital complete heart block and persistent ductus arteriosus associated with maternal systemic lupus erythematosus.  Br Heart J . 1981;  46 104-106
    PubMedGoogle Scholar
  • 26 Buyon J P, Waltuck J, Kleinman C, Copel J. In utero identification and therapy of congenital heart block.  Lupus . 1995;  4 116-121
    CrossrefPubMedGoogle Scholar
  • 27 van der Leij N J, Visser G H, Bink-Boelkens M T, Meilof J F, Kallenberg C G. Successful outcome of pregnancy afier treatment of maternal anti-Ro (SSA) antibodies with immunosuppressive therapy and plasmapheresis.  Prenat Diagn . 1994;  14 1003-1007
    PubMedGoogle Scholar
  • 28 Schmidt K G, Ulmer H E, Silverman N H, Kleinman C S, Copel J A. Perinatal outcome of fetal complete atrioventricular block: a multicenter experience.  Am Coll Cardiol . 1991;  17 1360-1366
    PubMedGoogle Scholar
  • 29 Olah K S, Gee H. Fetal heart block associated with maternal anti-Ro (SS-A) antibody-current management: a review.  Br J Obstet Gynaecol . 1991;  98 751-755
    PubMedGoogle Scholar
  • 30 Kaaja K, Julkunen H, Ammala P, Teppo A M, Kurki P. Congenital heart block: successful prophylactic treatment with intravenous gamma globulin and corticosteroid therapy.  Am J Obstet Gynecol . 1991;  165 1333-1334
    PubMedGoogle Scholar
  • 31 Friedman D M. Fetal echocardiography in the assessment of lupus pregnancies.  Am J Reprod Immunol . 1992;  28 164-167
    PubMedGoogle Scholar
  • 32 Shinohara K, Miyagawa S, Fujita T, Aono T, Kidoguchi K-I. Neonatal lupus erythematosus: results of maternal corticosteroid therapy.  Obstet Gynecol . 1999;  93 952-957
    CrossrefPubMedGoogle Scholar
  • 33 Buyon J P, Hiebert K, Copel J. Autoimmune-associated congenital heart block:demographics, mortality, morbidity and recurrence rates obtained from a national neonatal lupus registry.  J Am Coll Cardiol . 1998;  31 1658-1666
    CrossrefPubMedGoogle Scholar
  • 34 Buyon J P. Autoantibodies reactive with Ro(SSA) and La(S SB) and pregnancy.  J Rheumatol . 1997;  24 12-16
    PubMedGoogle Scholar
  • 35 Derksen R H, Meilof J F. Anti-Ro/SS-A and anti-La/SS-B autoantibody levels in relation to systemic lupus erythematosus disease activity and congenital heart block: a longitudinal study comprising two consecutive pregnancies in a patient with systemic lupus erythematosus.  Arthritis Rheum . 1992;  35 953-959
    PubMedGoogle Scholar