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

Gordon Gladman; Earl D. Silverman; null Yuk-Law; Lily Luy; Christine Boutin; Carl Laskin; Jeffrey F. Smallhorn

doi:10.1055/s-2002-23555

American Journal of Perinatology, Table of Contents

Am J Perinatol 2002; 19(2): 073-080
DOI: 10.1055/s-2002-23555

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

Gordon Gladman¹ , Earl D. Silverman^2, 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

Abstract

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

Full Text

References

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