Maternal autoantibody levels in congenital heart block and potential prophylaxis with antiinflammatory agents

Am J Obstet Gynecol. 2013 Jan;208(1):64.e1-7. doi: 10.1016/j.ajog.2012.09.020. Epub 2012 Sep 28.

Abstract

Objective: The importance of maternal autoantibody levels in congenital heart block and elucidation of maternal factors that may reduce disease burden require further clarification.

Study design: Pregnancies complicated by maternal anti-Ro antibodies from 2007 through 2011 were retrospectively reviewed.

Results: In all, 33 women were followed up throughout pregnancy. Semiquantitative maternal anti-La levels were significantly higher in pregnancies complicated by fetal heart block of any degree (median difference, 227.5; P = .04), but there was no difference in maternal anti-Ro levels. In all, 94% of fetuses maintained normal conduction when the mother was treated with hydroxychloroquine or daily prednisone therapy throughout pregnancy, compared to 59% in the untreated group (odds ratio, 0.1; P = .04).

Conclusion: Pregnancies complicated by fetal heart block did not have higher levels of maternal anti-Ro antibodies. Maternal anti-La level may be a useful predictor of fetal heart block. Maternal treatment with either hydroxychloroquine or daily low-dose prednisone throughout pregnancy may provide a protective effect.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Inflammatory Agents / therapeutic use*
  • Antibodies, Antinuclear / blood*
  • Antibodies, Antinuclear / immunology
  • Female
  • Heart Block / congenital*
  • Heart Block / drug therapy*
  • Heart Block / immunology
  • Humans
  • Hydroxychloroquine / therapeutic use*
  • Maternal-Fetal Exchange / immunology
  • Prednisone / therapeutic use*
  • Pregnancy
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Antibodies, Antinuclear
  • Hydroxychloroquine
  • Prednisone