Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e803-e809 (doi:10.1542/peds.2007-1659)
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ARTICLE

Outcome and Growth of Infants Fetally Exposed to Heart Block-Associated Maternal Anti-Ro52/SSA Autoantibodies

Amanda Skoga, Marie Wahren-Herlenius, MD, PhDa, Birgitta Sundström, RNb, Katarina Bremme, MD, PhDc and Sven-Erik Sonesson, MD, PhDb

a Rheumatology Unit, Department of Medicine
b Pediatric Cardiology Unit
c Obstetrics and Gynecology, Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden

OBJECTIVE. The purpose of this work was to analyze outcome with focus on growth in infants fetally exposed to heart block-associated maternal anti-Ro52/SSA autoantibodies and identify maternal factors other than the autoantibodies increasing the risk of fetal heart block.

PATIENTS AND METHODS. Thirty-two pregnancies in 30 anti-Ro52-positive mothers were included. Seven fetuses developed second-degree or third-degree atrioventricular block, 8 developed first-degree atrioventricular block, and 17 had normal atrioventricular conduction, as diagnosed by using Doppler echocardiography. Three of 6 surviving fetuses with second-degree or third-degree atrioventricular block received treatment with fluorinated steroids. Two fetuses with second-degree atrioventricular block converted to first-degree atrioventricular block without any signs of progression during the study period. Maternal and longitudinal infant data were collected from planned neonatal follow-up and childhood health records from birth to 12 months of age in 31 survivors.

RESULTS. Women giving birth to infants with prenatal second-degree or third-degree atrioventricular block were older and with higher parity than those with first-degree atrioventricular block or normal atrioventricular conduction. Second-degree or third-degree atrioventricular block pregnancies were <40 completed weeks, whereas pregnancies with first-degree atrioventricular block or normal atrioventricular conduction had a normal duration. Fetuses with second-degree or third-degree atrioventricular block were retarded by –0.98 ± 0.77 SD in weight at birth and did not show any catch-up during infancy. In contrast, fetuses with first-degree atrioventricular block or normal atrioventricular conduction had a weight reduction of –0.51 ± 1.01 SD with a catch-up during the first months after birth.

CONCLUSIONS. This report documents that newborns with autoantibody-mediated second-degree or third-degree atrioventricular block are retarded in growth, with no catch-up during infancy, whereas fetuses with first-degree atrioventricular block or normal atrioventricular conduction have a normal growth soon after birth. Increased maternal age and/or parity seem to carry an increased risk for fetal heart block.

Key Words: infant • weight • length • autoantibodies • Ro/SSA • congenital heart block

Abbreviations: SLE—systemic lupus erythematosus • SS—Sjögren's syndrome • AVB—atrioventricular block • ECG—electrocardiogram • NC—normal atrioventricular conduction • AVB II-III—second-degree or third-degree atrioventricular block • AVB I—first-degree atrioventricular block

Accepted Sep 4, 2007.