Serial echocardiography for immune-mediated heart disease in the fetus: results of a risk-based prospective surveillance strategy.
OBJECTIVE
Mothers carrying anti-Ro antibodies are frequently referred for weekly echocardiograms to early detect and treat antibody-mediated fetal heart disease. We tested a surveillance strategy based on anti-Ro antibody titers.


METHODS
From 2009 to 2014, 232 pregnancies were referred for maternal anti-Ro antibodies. At the baseline echocardiogram, anti-Ro titers were measured by enzyme-linked immunosorbent essay and results categorized as negative (<8 U/mL; n = 43; excluded), low-moderate positive (8-49 U/mL; n = 62; group 1) or high positive (50 - >100 U/mL; n = 127; group 2). Serial echocardiograms to ≥24 weeks were only recommended for group 2 mothers.


RESULTS
Group 1 patients underwent significantly less fetal echocardiograms when compared with group 2 mothers (median 2 vs. 4; p < 0.001). Isolated endocardial fibroelastosis (n = 1) and incomplete (n = 4) or complete (n = 4) heart block were diagnosed in 9 (8%) pregnancies with anti-Ro titers >100 U/mL but none with lower titers (odds ratio 17.78; p = 0.004). Incomplete block and endocardial fibroelastosis regressed with transplacental corticosteroid and immune globulin therapy.


CONCLUSIONS
Limiting serial fetal echocardiograms to women with high anti-Ro antibody levels is safe and more cost effective. While numbers of echocardiograms were significantly reduced in referrals with anti-Ro titers <50 U/mL, reversible abnormalities with prenatal treatment were detected by serial echocardiography in group 2 patients. © 2017 John Wiley & Sons, Ltd.
Fetal Cardiac Program, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada.
Nobuhiko
N
Kan
Department of Immunology, Hospital for Sick Children, University of Toronto, Toronto, Canada.
Earl D
ED
Silverman
Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
John
J
Kingdom
Fetal Cardiac Program, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada.
Nathalie
N
Dutil
Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
Carl
C
Laskin
Fetal Cardiac Program, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada.
Edgar
http://orcid.org/0000-0002-9012-6592
E
Jaeggi
D000328:Adult; D004452:Echocardiography / Q000379:methods; D004695:Endocardial Fibroelastosis / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000188:drug therapy; D005323:Fetal Monitoring / Q000379:methods*; D006327:Heart Block / Q000151:congenital / Q000175:diagnosis / Q000188:drug therapy; D006331:Heart Diseases / Q000151:congenital / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007154:Immune System Diseases / Q000151:congenital / Q000175:diagnosis* / Q000188:drug therapy; D007155:Immunologic Factors / Q000627:therapeutic use; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055815:Young Adult
D007155:Immunologic Factors