Outcome of pregnancies in patients with anti-SSA/Ro antibodies: a study of 165 pregnancies, with special focus on electrocardiographic variations in the children and comparison with a control group.
OBJECTIVE
Aside from congenital heart block (CHB), sinus bradycardia and prolongation of the corrected QT (QTc) interval have been reported in infants born to mothers with anti-SSA antibodies. To assess the pathologic nature of these manifestations, this study focused on electrocardiographic (EKG) variations in these children, comparing them with findings in a control group.


METHODS
We studied 165 consecutive pregnancies in 106 anti-SSA-positive women with connective tissue diseases (CTDs). EKGs obtained on 58 children of this group were compared with those obtained on 85 infants born to mothers with CTD who were negative for both anti-SSA and anti-SSB.


RESULTS
No statistically significant difference was seen between the 2 study groups with regard to gestational age, prematurity, birth weight, age of the children at the time of EKG, age of the mothers, or treatments received by the mothers during their pregnancies. Seven of 137 children developed cutaneous neonatal lupus syndrome; 1 child developed CHB (CHB risk of 1 in 99 [1%] if only the first prospectively observed pregnancy in women without a history of CHB is included in the analysis). For EKGs recorded during the first 2 months of life, the mean +/- SD PR interval was 96 +/- 16 msec in the anti-SSA-positive group and 96 +/- 13 msec in the anti-SSA-negative group (P = 0.84), with mean QTc values of 397 +/- 27 and 395 +/- 25 msec (P = 0.57) and mean heart rates of 141 +/- 23 and 137 +/- 21 beats per minute (P = 0.20), respectively. No difference in the PR interval, QTc interval, or heart rate was observed for EKGs obtained between 2 and 4 months of life. When EKGs obtained at 0-2 months were compared with those obtained at 2-4 months, a physiologic prolongation of the QTc interval was observed in both study groups. No sudden infant death or symptomatic arrhythmia occurred during the first year of life.


CONCLUSIONS
The EKG findings in children of anti-SSA-positive and anti-SSA-negative mothers were not significantly different. Our results suggest that the prolongation of the QTc interval and sinus bradycardia that have recently been reported in children of mothers with anti-SSA antibodies occur independently of the anti-SSA antibodies. The pathologic nature of these EKG variations was not confirmed by our controlled study.
Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France. nathalie.costedoat@psl.ap-hop-paris.fr
Nathalie
N
Costedoat-Chalumeau
Zahir
Z
Amoura
Jean-Marc
JM
Lupoglazoff
Du Le Thi
DL
Huong
Isabelle
I
Denjoy
Danièle
D
Vauthier
Djamel
D
Sebbouh
Olivier
O
Fain
Sophie
S
Georgin-Lavialle
Pascale
P
Ghillani
Lucile
L
Musset
Bertrand
B
Wechsler
Pierre
P
Duhaut
Jean-Charles
JC
Piette
D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood*; D001919:Bradycardia / Q000209:etiology; D000013:Congenital Abnormalities; D003240:Connective Tissue Diseases; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D008178:Lupus Erythematosus, Cutaneous / Q000151:congenital; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome
D000974:Antibodies, Antinuclear; C035356:SS-A antibodies; C035357:SS-B antibodies