Download PDF
Am J Perinatol 2015; 32(13): 1240-1246
DOI: 10.1055/s-0035-1552942
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fetuses of Mothers with Thyroid Disease May Be at Higher Risk of Developing Supraventricular Tachycardia

Jennifer A. Johnson
1   Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
2   Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
,
Paula Williams
3   Division of Pediatric Cardiology, Department of Pediatrics, University of Chicago, Chicago, Illinois
,
Zengqi Lu
4   Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
,
Ann Kavanaugh-McHugh
2   Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
,
Frank A. Fish
2   Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
,
Stacy A. S. Killen
2   Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
› Author Affiliations
Further Information

Publication History

17 June 2014

01 April 2015

Publication Date:
03 June 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Objective Fetal tachyarrhythmias complicate 0.5% of pregnancies, with high morbidity and mortality. We hypothesized that maternal factors may predispose to fetal supraventricular tachycardia (SVT).

Study Design We reviewed medical records of all 124 mothers who presented to the Vanderbilt Fetal Cardiology Clinic from 2004 to 2010 for fetal arrhythmias, excluding heart block. Maternal factors were compared between 28 fetuses with SVT and a control group of 112 fetuses screened for noncardiac conditions. The proportions were analyzed using chi-square or Fisher exact test for categorical variables and Wilcoxon rank sum test for continuous variables.

Results Of maternal factors, thyroid disease was statistically significant compared with controls. Among mothers whose fetuses had SVT, 21% had thyroid disease (83% hypothyroidism) compared with 3% of controls (p < 0.001).

Conclusion In this cohort, the maternal thyroid disease was more common in fetuses with SVT compared with controls (odds ratio = 9.8, 95% confidence interval 2.3–42.3), suggesting closer screening for fetal arrhythmias and SVT in mothers with thyroid disease. Also, routine screening of thyroid functions and thyroid autoantibodies may be warranted in mothers of fetuses with SVT.

Keywords

fetal arrhythmias - supraventricular tachycardia - thyroid disease - autoimmune disease
 

  • References

  • 1 Simpson LL. Fetal supraventricular tachycardias: diagnosis and management. Semin Perinatol 2000; 24 (5) 360-372
    CrossrefPubMedGoogle Scholar
  • 2 Southall DP, Richards J, Hardwick RA , et al. Prospective study of fetal heart rate and rhythm patterns. Arch Dis Child 1980; 55 (7) 506-511
    CrossrefPubMedGoogle Scholar
  • 3 Strasburger JF. Fetal arrhythmias. Prog Pediatr Cardiol 2000; 11 (1) 1-17
    CrossrefPubMedGoogle Scholar
  • 4 Cuneo BF. Treatment of fetal tachycardia. Heart Rhythm 2008; 5 (8) 1216-1218
    CrossrefPubMedGoogle Scholar
  • 5 Jaeggi ET, Carvalho JS, De Groot E , et al. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation 2011; 124 (16) 1747-1754
    CrossrefPubMedGoogle Scholar
  • 6 Boldt T, Eronen M, Andersson S. Long-term outcome in fetuses with cardiac arrhythmias. Obstet Gynecol 2003; 102 (6) 1372-1379
    CrossrefPubMedGoogle Scholar
  • 7 Rasiah SV, Ewer AK, Miller P, Kilby MD. Prenatal diagnosis, management and outcome of fetal dysrhythmia: a tertiary fetal medicine centre experience over an eight-year period. Fetal Diagn Ther 2011; 30 (2) 122-127
    CrossrefPubMedGoogle Scholar
  • 8 Simpson JM, Sharland GK. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart 1998; 79 (6) 576-581
    CrossrefPubMedGoogle Scholar
  • 9 Naheed ZJ, Strasburger JF, Deal BJ, Benson Jr DW, Gidding SS. Fetal tachycardia: mechanisms and predictors of hydrops fetalis. J Am Coll Cardiol 1996; 27 (7) 1736-1740
    CrossrefPubMedGoogle Scholar
  • 10 Larmay HJ, Strasburger JF. Differential diagnosis and management of the fetus and newborn with an irregular or abnormal heart rate. Pediatr Clin North Am 2004; 51 (4) 1033-1050 , xx
    CrossrefPubMedGoogle Scholar
  • 11 Till J, Wren C. Atrial flutter in the fetus and young infant: an association with accessory connections. Br Heart J 1992; 67 (1) 80-83
    CrossrefPubMedGoogle Scholar
  • 12 Johnson Jr WH, Dunnigan A, Fehr P, Benson Jr DW. Association of atrial flutter with orthodromic reciprocating fetal tachycardia. Am J Cardiol 1987; 59 (4) 374-375
    CrossrefPubMedGoogle Scholar
  • 13 Hahurij ND, Gittenberger-De Groot AC, Kolditz DP , et al. Accessory atrioventricular myocardial connections in the developing human heart: relevance for perinatal supraventricular tachycardias. Circulation 2008; 117 (22) 2850-2858
    CrossrefPubMedGoogle Scholar
  • 14 Krapp M, Kohl T, Simpson JM, Sharland GK, Katalinic A, Gembruch U. Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart 2003; 89 (8) 913-917
    CrossrefPubMedGoogle Scholar
  • 15 Moodley S, Sanatani S, Potts JE, Sandor GG. Postnatal outcome in patients with fetal tachycardia. Pediatr Cardiol 2013; 34 (1) 81-87
    CrossrefPubMedGoogle Scholar
  • 16 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (2) 377-381
    CrossrefPubMedGoogle Scholar
  • 17 Strasburger JF. Prenatal diagnosis of fetal arrhythmias. Clin Perinatol 2005; 32 (4) 891-912 , viii
    CrossrefPubMedGoogle Scholar
  • 18 Liu S, Joseph KS, Lisonkova S , et al; Canadian Perinatal Surveillance System (Public Health Agency of Canada). Association between maternal chronic conditions and congenital heart defects: a population-based cohort study. Circulation 2013; 128 (6) 583-589
    CrossrefPubMedGoogle Scholar
  • 19 Negro R, Mestman JH. Thyroid disease in pregnancy. Best Pract Res Clin Endocrinol Metab 2011; 25 (6) 927-943
    CrossrefPubMedGoogle Scholar
  • 20 Stagnaro-Green A, Roman SH, Cobin RH, el-Harazy E, Alvarez-Marfany M, Davies TF. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA 1990; 264 (11) 1422-1425
    CrossrefPubMedGoogle Scholar
  • 21 Neale DM, Cootauco AC, Burrow G. Thyroid disease in pregnancy. Clin Perinatol 2007; 34 (4) 543-557 , v–vi
    CrossrefPubMedGoogle Scholar
  • 22 Borchers AT, Naguwa SM, Keen CL, Gershwin ME. The implications of autoimmunity and pregnancy. J Autoimmun 2010; 34 (3) J287-J299
    CrossrefPubMedGoogle Scholar
  • 23 Lazarus JH. Screening for thyroid dysfunction in pregnancy: is it worthwhile?. J Thyroid Res 2011; 2011: 397012
    PubMedGoogle Scholar
  • 24 Männistö T, Vääräsmäki M, Pouta A , et al. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study. J Clin Endocrinol Metab 2009; 94 (3) 772-779
    CrossrefPubMedGoogle Scholar
  • 25 Carvalheiras G, Faria R, Braga J, Vasconcelos C. Fetal outcome in autoimmune diseases. Autoimmun Rev 2012; 11 (6-7) A520-A530
    CrossrefPubMedGoogle Scholar
  • 26 Lazarus JH. Epidemiology and prevention of thyroid disease in pregnancy. Thyroid 2002; 12 (10) 861-865
    CrossrefPubMedGoogle Scholar
  • 27 Weetman AP. The immunology of pregnancy. Thyroid 1999; 9 (7) 643-646
    CrossrefPubMedGoogle Scholar
  • 28 Jaeggi E, Laskin C, Hamilton R, Kingdom J, Silverman E. The importance of the level of maternal anti-Ro/SSA antibodies as a prognostic marker of the development of cardiac neonatal lupus erythematosus a prospective study of 186 antibody-exposed fetuses and infants. J Am Coll Cardiol 2010; 55 (24) 2778-2784
    CrossrefPubMedGoogle Scholar
  • 29 Spence D, Hornberger L, Hamilton R, Silverman ED. Increased risk of complete congenital heart block in infants born to women with hypothyroidism and anti-Ro and/or anti-La antibodies. J Rheumatol 2006; 33 (1) 167-170
    PubMedGoogle Scholar
  • 30 Pike JI, Krishnan A, Kaltman J, Donofrio MT. Fetal and neonatal atrial arrhythmias: an association with maternal diabetes and neonatal macrosomia. Prenat Diagn 2013; 33 (12) 1152-1157
    CrossrefPubMedGoogle Scholar