Complete Congenital Heart Block in the Offspring of an Asymptomatic Woman with Isolated High Titer Anti-Ro Antibody

Abstract

Among pregnant women, 1-2% are anti-Ro positive and while half of them have symptoms of connective tissuedisease, the rest are asymptomatic. The presence of anti-Ro is of concern because of the risk of congenital heartblock in the child.We report the case of an asymptomatic 27-year-old G2P1(1001) woman, who presented with persistent fetalbradycardia in her 21st week of gestation (AOG) and was found to have elevated titers for anti-Ro (>320 U/ml).Hydroxychloroquine 200 mg/day and prednisone 10 mg/day were given from the 33rd week of gestation up until the delivery. At 37 weeks AOG, she delivered a live male neonate with a complete heart block. On the 6th day of life, the infant remained bradycardic, hence a pacemaker was inserted and heart rate maintained at 100-120 bpm. On subsequent follow-ups, the mother and child did not develop any systemic manifestations and the infant was thriving well.While a diseased condition may not be apparent in a pregnant anti-Ro positive woman, the risk of neonatal lupus (NL) is demonstrated in this patient’s case. This report illustrates how prenatal care of an asymptomatic woman led to the discovery of a fetal abnormality and served to prepare the family and the medical team to ably handle the birth and subsequent care of a neonate with NL.