title: The predictive value of anti-SS-A antibodies titration in pregnant women with fetal congenital heart block.
abstract: OBJECTIVE
  Fetal congenital complete heart block (CHB) is irreversible and is associated with significant mortality and morbidity. Anti-SS-A antibodies in the maternal sera are involved in its pathogenesis; however, the predictive value of the antibody titer and its role in prediction of this complication are controversial. The aim of this study was to determine the predictive value of maternal anti-SS-A antibodies on the development of fetal CHB.
  
  
  METHODS
  A retrospective chart review was performed for 189 cases of positive anti-SS-A antibodies determined by the double immunodiffusion (DID) method, and included 17 patients that developed fetal CHB. The relationship between the appearance of CHB and the anti-SS-A antibodies titer was examined.
  
  
  RESULTS
  An anti-SS-A antibodies titer of 1:32 or higher was identified by analyzing the receiver-operating characteristics (area under curve 0.72) curve. An anti-SS-A antibodies titer of 32 or more times greater than the upper limit by DID was a risk factor for fetal CHB (odds ratio 27.77, 95% confidence interval (CI) 1.91-21.02, P < 0.05) in the multivariate analysis. Among 107 cases of anti-SS-A antibodies titers of 1:32 or higher, 65 patients (60.7%) were treated with oral steroids. Of these, four patients had CHB (6.2%). This rate of CHB was significantly lower (P < 0.01) than the rate in patients not treated with steroids.
  
  
  CONCLUSIONS
  An anti-SS-A antibodies titer of 1:32 or higher in the maternal sera by DID was an independent risk factor for fetal CHB. In these patients, either antenatally administered prednisolone or betamethasone, was associated with a lower risk of fetal CHB.
authors: Department of Obstetrics and Gynecology, Kyushu University Hospital, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
authors: Ai
authors: A
authors: Anami
authors: Kotaro
authors: K
authors: Fukushima
authors: Yoshinari
authors: Y
authors: Takasaki
authors: Takayuki
authors: T
authors: Sumida
authors: Masako
authors: M
authors: Waguri
authors: Norio
authors: N
authors: Wake
authors: Atsuko
authors: A
authors: Murashima
mesh_terms: D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000032:analysis*; D000974:Antibodies, Antinuclear / Q000276:immunology*; D005260:Female; D006327:Heart Block / Q000151:congenital* / Q000276:immunology; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology*; D012189:Retrospective Studies
chemical_list: D000888:Antibodies, Anti-Idiotypic; D000974:Antibodies, Antinuclear; C035356:SS-A antibodies