Outcome and growth of infants fetally exposed to heart block-associated maternal anti-Ro52/SSA autoantibodies.
OBJECTIVE
The purpose of this work was to analyze outcome with focus on growth in infants fetally exposed to heart block-associated maternal anti-Ro52/SSA autoantibodies and identify maternal factors other than the autoantibodies increasing the risk of fetal heart block.


METHODS
Thirty-two pregnancies in 30 anti-Ro52-positive mothers were included. Seven fetuses developed second-degree or third-degree atrioventricular block, 8 developed first-degree atrioventricular block, and 17 had normal atrioventricular conduction, as diagnosed by using Doppler echocardiography. Three of 6 surviving fetuses with second-degree or third-degree atrioventricular block received treatment with fluorinated steroids. Two fetuses with second-degree atrioventricular block converted to first-degree atrioventricular block without any signs of progression during the study period. Maternal and longitudinal infant data were collected from planned neonatal follow-up and childhood health records from birth to 12 months of age in 31 survivors.


RESULTS
Women giving birth to infants with prenatal second-degree or third-degree atrioventricular block were older and with higher parity than those with first-degree atrioventricular block or normal atrioventricular conduction. Second-degree or third-degree atrioventricular block pregnancies were <40 completed weeks, whereas pregnancies with first-degree atrioventricular block or normal atrioventricular conduction had a normal duration. Fetuses with second-degree or third-degree atrioventricular block were retarded by -0.98 +/- 0.77 SD in weight at birth and did not show any catch-up during infancy. In contrast, fetuses with first-degree atrioventricular block or normal atrioventricular conduction had a weight reduction of -0.51 +/- 1.01 SD with a catch-up during the first months after birth.


CONCLUSIONS
This report documents that newborns with autoantibody-mediated second-degree or third-degree atrioventricular block are retarded in growth, with no catch-up during infancy, whereas fetuses with first-degree atrioventricular block or normal atrioventricular conduction have a normal growth soon after birth. Increased maternal age and/or parity seem to carry an increased risk for fetal heart block.
Skog
Amanda
A
Rheumatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Wahren-Herlenius
Marie
M
Sundström
Birgitta
B
Bremme
Katarina
K
Sonesson
Sven-Erik
SE
D000974:Antibodies, Antinuclear / Q000097:blood* / Q000276:immunology; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D047109:Fetal Development / Q000502:physiology; D005315:Fetal Diseases / Q000453:epidemiology / Q000276:immunology*; D005500:Follow-Up Studies; D005865:Gestational Age; D006327:Heart Block / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D010298:Parity; D021041:Placental Circulation / Q000276:immunology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000276:immunology*; D011256:Pregnancy Outcome; D012261:Ribonucleoproteins / Q000276:immunology; D012307:Risk Factors; D000099207:SS-A Antigen
D000974:Antibodies, Antinuclear; D001323:Autoantibodies; D012261:Ribonucleoproteins; D000099207:SS-A Antigen; C035356:SS-A antibodies