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Anti-SSA/Ro positivity and congenital heart block: obstetric and foetal outcome in a cohort of anti-SSA/Ro positive pregnant patients with and without autoimmune diseases


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21

 

  1. Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy.
  2. Division of Clinical Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy.
  3. Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy.
  4. Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
  5. Division of Rheumatology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  6. Obstetrics and Gynecology Unit, ASST Spedali Civili of Brescia, Italy.
  7. Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy.
  8. Division of Clinical Rheumatology, ASST Gaetano Pini-CTO, Research Center for Adult and Paediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Italy.
  9. Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
  10. Division of Rheumatology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  11. Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy.
  12. Obstetrics and Gynecology Unit, ASST Garda, Desenzano Hospital, Italy.
  13. Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
  14. Division of Rheumatology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  15. Paediatric Rheumatology Unit, ASST G. Pini-CTO, Research Center for Adult and Paediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Italy.
  16. Experimental Laboratory of ImmunoRheumatological Researches, IRCCS Istituto Auxologico Italiano, Cusano Milanino, Italy.
  17. Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy.
  18. Paediatric Rheumatology Unit, ASST G. Pini-CTO, Research Center for Adult and Paediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Italy.
  19. Division of Clinical Rheumatology, ASST Gaetano Pini-CTO, Research Center for Adult and Paediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Italy.
  20. Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy, and I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia.
  21. Division of Clinical Rheumatology, ASST Gaetano Pini-CTO, Research Centre for Adult and Paediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Italy. maria.gerosa@unimi.it

CER15620
2023 Vol.41, N°3
PI 0685, PF 0693
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PMID: 36377571 [PubMed]

Received: 22/02/2022
Accepted : 07/06/2022
In Press: 12/11/2022
Published: 23/03/2023

Abstract

OBJECTIVES:
Neonatal lupus (NL) is an acquired disease caused by the transplacental passage of anti-SSA/Ro antibodies. The rate of congenital heart block (CHB), its most serious manifestation, ranges from 1 to 5%. The aim of this study was to retrospectively assess the prevalence of CHB in anti-SSA/Ro positive pregnant women with or without systemic autoimmune diseases from 2010 to 2020.
METHODS:
Patients underwent monthly visit and a shared follow-up programme of weekly (16th-24th week) foetal heart rate assessment by obstetric ultrasound.
RESULTS:
322 pregnancies in 258 anti-SSA/Ro patients were included; 314 were followed from the beginning of pregnancy because of the known presence of anti-SSA/Ro autoantibodies and 1 case of CHB occurred in an anti-SSA/Ro+ asymptomatic subject (0.3%). In the same period, 8 additional patients were referred to our clinics after in utero CHB diagnosis and subsequent discovery of anti-SSA/Ro without a disease diagnosis. Globally, 9 cases of congenital CHB (2.8%) occurred: 7 complete, 1 II-III degree and 1 rst degree CHB. Anti-SSB/La positivity was associated with a higher risk of CHB (7.8% vs. 1.2%; p=0.0071). No differences in maternal or foetal outcomes were found in comparison with a large cohort of unselected pregnancies except for caesarian section. Hydroxychloroquine (HCQ) was used in 58.3% pregnancies, with a different prevalence according with maternal diagnosis.
CONCLUSIONS:
Our data suggest that anti-SSA/Ro positive patents with a de ned systemic autoimmune disease undergoing a strict follow-up since positive pregnancy test display a low risk of pregnancy complications, including but not limited to NL.

DOI: https://doi.org/10.55563/clinexprheumatol/2ju0yv

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