title: Maternal predictive factors for fetal congenital heart block in pregnant mothers positive for anti-SS-A antibodies.
abstract: OBJECTIVE
  To determine the maternal predictive factors for fetal congenital heart block (CHB) in pregnancy in mothers positive for anti-SS-A antibodies.
  
  
  METHODS
  The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare, performed a national survey on pregnancy of mothers positive for anti-SS-A antibodies. We analyzed 635 pregnant mothers who tested positive for anti-SS-A antibodies before conception but had no previous history of fetal CHB. We performed univariate and multivariate analysis (models 1, 2, and 3 using different set of independent variables) investigated the relation between risk of fetal CHB and maternal clinical features.
  
  
  RESULTS
  Of the 635 pregnant mothers, fetal CHB was detected in 16. Univariate analysis showed that fetal CHB associated with use of corticosteroids before conception (OR 3.72, p = 0.04), and negatively with use of corticosteroids (equivalent doses of prednisolone (PSL), at ≥10 mg/day) after conception before 16-week gestation (OR 0.17, p = 0.03). In multivariate analysis, model 1 identified the use of corticosteroids before conception (OR 4.28, p = 0.04) and high titer of anti-SS-A antibodies (OR 3.58, p = 0.02) as independent and significant risk factors, and model 3 identified use of corticosteroids (equivalent doses of PSL, at ≥10 mg/day) after conception before 16-week gestation as independent protective factor against the development of fetal CHB (OR 0.16, p = 0.03). Other maternal clinical features did not influence the development of fetal CHB.
  
  
  CONCLUSIONS
  The results identified high titers of anti-SS-A antibodies and use of corticosteroids before conception as independent risk factors, and use of corticosteroids (equivalent doses of PSL, at ≥10 mg/day) after conception before 16-week gestation as an independent protective factor for fetal CHB.
authors.affiliation: a Department of Internal Medicine , Faculty of Medicine, University of Tsukuba , Ibaraki , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Tsuboi
authors.affiliation: a Department of Internal Medicine , Faculty of Medicine, University of Tsukuba , Ibaraki , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Sumida
authors.affiliation: b Department of Data Science , The Institute of Statistical Mathematics , Tokyo , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Noma
authors.affiliation: c Department of Public Health Medicine , Faculty of Medicine, University of Tsukuba , Ibaraki , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yamagishi
authors.affiliation: d Department of Obstetrics and Gynecology , Kyushu University Hospital , Fukuoka , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Anami
authors.affiliation: d Department of Obstetrics and Gynecology , Kyushu University Hospital , Fukuoka , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Fukushima
authors.affiliation: e Department of Child Health , Faculty of Medicine, University of Tsukuba , Ibaraki , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Horigome
authors.affiliation: f The Department of Pediatrics and Child Health , Kurume University School of Medicine , Fukuoka , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Maeno
authors.affiliation: g Immuno-Rheumatology Center, St Luke's International Hospital , Tokyo , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Kishimoto
authors.affiliation: h Department of Rheumatology , School of Medicine, Juntendo University , Tokyo , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
authors.affiliation: i Department of Laboratory Medicine , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakayama
authors.affiliation: j Department of Maternal Medicine , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Waguri
authors.affiliation: k Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development , Tokyo , Japan .|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
authors.affiliation: l Department of Maternal Medicine , National Center for Child Health and Development , Tokyo , Japan , and.|m The Research Team for Surveillance of Autoantibody-Exposed Fetuses and Treatment of Neonatal Lupus Erythematosus, the Research Program of the Japan Ministry of Health, Labor and Welfare (MHLW) (H22-Jisedai-Ippan-007) , Tokyo , Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Murashima
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood*; D001323:Autoantibodies / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006306:Health Surveys; D006327:Heart Block / Q000151:congenital* / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D007564:Japan; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000188:drug therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D065840:Protective Factors; D012307:Risk Factors; D013223:Statistics as Topic
chemical_list: D000974:Antibodies, Antinuclear; D001323:Autoantibodies; D005938:Glucocorticoids; C035356:SS-A antibodies
keywords: Anti-SS-A antibodies; Congenital heart block; Risk factor