Maternal autoantibody levels in congenital heart block and potential prophylaxis with antiinflammatory agents.
OBJECTIVE
The importance of maternal autoantibody levels in congenital heart block and elucidation of maternal factors that may reduce disease burden require further clarification.


METHODS
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).


CONCLUSIONS
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.
Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.
Robert D
RD
Tunks
Megan E B
ME
Clowse
Stephen G
SG
Miller
Leo R
LR
Brancazio
Piers C A
PC
Barker
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000974:Antibodies, Antinuclear / Q000097:blood* / Q000276:immunology; D005260:Female; D006327:Heart Block / Q000151:congenital* / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D008431:Maternal-Fetal Exchange / Q000276:immunology; D011241:Prednisone / Q000627:therapeutic use*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000974:Antibodies, Antinuclear; D006886:Hydroxychloroquine; D011241:Prednisone