title: Heart sounds at home: feasibility of an ambulatory fetal heart rhythm surveillance program for anti-SSA-positive pregnancies.
abstract: Fetuses exposed to anti-SSA (Sjögren's) antibodies are at risk of developing irreversible complete atrioventricular block (CAVB), resulting in death or permanent cardiac pacing. Anti-inflammatory treatment during the transition period from normal heart rhythm (fetal heart rhythm (FHR)) to CAVB (emergent CAVB) can restore sinus rhythm, but detection of emergent CAVB is challenging, because it can develop in ⩽24 h. We tested the feasibility of a new technique that relies on home FHR monitoring by the mother, to surveil for emergent CAVB.
  
  
  
  We recruited anti-SSA-positive mothers at 16 to 18 weeks gestation (baseline) from 8 centers and instructed them to monitor FHR two times a day until 26 weeks, using a Doppler device at home. FHR was also surveilled by weekly or every other week fetal echo. If FHR was irregular, the mother underwent additional fetal echo. We compared maternal stress/anxiety before and after monitoring. Postnatally, infants underwent a 12-lead electrocardiogram.
  
  
  
  Among 133 recruited, 125 (94%) enrolled. Among those enrolled, 96% completed the study. Reasons for withdrawal (n=5) were as follows: termination of pregnancy, monitoring too time consuming or moved away. During home monitoring, 9 (7.5%) mothers detected irregular FHR diagnosed by fetal echo as normal (false positive, n=2) or benign atrial arrhythmia (n=7). No CAVB was undetected or developed after monitoring. Questionnaire analysis indicated mothers felt comforted by the experience and would monitor again in future pregnancies.
  
  
  
  These data suggest ambulatory FHR surveillance of anti-SSA-positive pregnancies is feasible, has a low false positive rate and is empowering to mothers.
authors.affiliation: The Heart Institute, Department of Pediatrics, Children's Hospital Colorado, Aurora CO, USA.
authors.forename: B F
authors.initials: BF
authors.lastname: Cuneo
authors.affiliation: Section of Cardiology, Department of Pediatrics, University of California-San Francisco Benioff Children's Hospital, San Francisco, CA, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Moon-Grady
authors.affiliation: Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
authors.forename: S-E
authors.initials: SE
authors.lastname: Sonesson
authors.affiliation: Section of Cardiology, Department of Pediatrics, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Levasseur
authors.affiliation: Stollery Children's Hospital, Edmonton, AB, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Hornberger
authors.affiliation: Section of Cardiology, Department of Pediatrics, Washington National Children's Hospital, Washington, DC, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Donofrio
authors.affiliation: Section of Cardiology, Department of Pediatrics, Washington National Children's Hospital, Washington, DC, USA.
authors.forename: A
authors.initials: A
authors.lastname: Krishnan
authors.affiliation: Section of Cardiology, Department of Pediatrics, Children's Hospital Philadelphia, Philadelphia, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Szwast
authors.affiliation: The Heart Institute, Department of Pediatrics, Children's Hospital Colorado, Aurora CO, USA.
authors.forename: L
authors.initials: L
authors.lastname: Howley
authors.affiliation: Section of Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Benson
authors.affiliation: The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Jaeggi
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood*; D054537:Atrioventricular Block / Q000175:diagnosis; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006347:Heart Sounds; D006801:Humans; D018670:Monitoring, Ambulatory / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis; D011295:Prenatal Care / Q000379:methods*; D011446:Prospective Studies; D018608:Ultrasonography, Doppler; D014481:United States
chemical_list: D000974:Antibodies, Antinuclear