Fetal screening and prevention of autoimmune heart block: What about the French cardiofetalist practice?

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Fetal autoimmune congenital heart block (CHB) is often diagnosed at an irreversible stage with a high related morbi-mortality. Cardiologic screening and preventive therapy during pregnancy are still not consensual. The objective of this study was to evaluate the prenatal follow up and management of pregnant women with anti-Ro/Sjögren's syndrome antigen A (SSA) or anti-La/Sjögren's syndrome antigen B (SSB) antibodies, among the French community of fetal cardiologists. Nationwide digital questionnaires were sent to the French community of fetal cardiologists. Fetal cardiologists were asked about their management, follow up, preventive care and curative therapy used in immune pregnancies with a CHB risk. Among the 45 fetal cardiologists surveyed, 38 (84%) accepted to respond. Regarding the follow-up of immune pregnancies, 97% of fetal cardiologists use to perform a dedicated systematic fetal echocardiography, twice a month, from 18 to 26 weeks of gestation. A more frequent and longer screening is usually performed for women who experienced a previous fetal immune CHB. 38% of fetal cardiologists would also propose a self-monitoring of fetal heart rate to complete their regular follow up. Regarding preventive therapy of fetal autoimmune CHB, the use of Hydroxychloroquine is recommended by 48% of fetal cardiologists. 43% would use bethametasone in case of a 1st and 2nd degree CHD and 24% in case of a 3rd CHD. 16% would also prescribe beta-mimetic drugs in case of 3rd atrio-ventricular block with fetal bradycardia. Treatments are usually introduced after a shared decision with internal medicine physicians and obstetricians. Most French fetal cardiologists perform a regular systematic follow-up in immune pregnancies with a CHB risk. This screening could be associated with a fetal heart rate self-monitoring at home. Preventive and curative therapies of CHD are still not consensual and rarely used, which is in line with their poor published efficacy.