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DOI: 10.1055/s-2002-23555
Fetal Echocardiographic Screening of Pregnancies of Mothers with Anti-Ro and/or Anti-La Antibodies
Publikationsverlauf
Publikationsdatum:
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
- 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
- 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
- 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
- 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
- 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
- 7 Waltuck J, Buyon J P. Autoantibody-associated congenital heart block: outcome in mothers and children. Ann Intern Med . 1994; 120 544-551
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 19 Hogg G. Congenital acute lupus erythematosus associated with subendocardial fibroelastosis. Am J Clin Pathol . 1957; 28 648-654
- 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
- 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
- 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
- 23 Carter J B, Blieden L C, Edwards J E. Congenital heart block. Arch Pathol . 1974; 97 51-57
- 24 James T N. Cardiac conduction system: fetal and postnatal development. Am J Cardiol . 1970; 25 213-226
- 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
- 26 Buyon J P, Waltuck J, Kleinman C, Copel J. In utero identification and therapy of congenital heart block. Lupus . 1995; 4 116-121
- 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
- 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
- 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
- 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
- 31 Friedman D M. Fetal echocardiography in the assessment of lupus pregnancies. Am J Reprod Immunol . 1992; 28 164-167
- 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
- 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
- 34 Buyon J P. Autoantibodies reactive with Ro(SSA) and La(S SB) and pregnancy. J Rheumatol . 1997; 24 12-16
- 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