Maternal autoantibodies and congenital heart block

Abstract

Introduction: Autoimmune congenital heart block (CHB) of the fetus is the severest manifestation of neonatal lupus, and it is damage of AV node of the fetus that is the root cause problem. Congenital heart block is mainly associated with maternal Systemic Lupus Erythematous (SLE) and anti-Ro and anti-La positive maternal status. This observational study was done to know the incidence of congenital heart block in patients of Systemic Lupus Erythematous who had ANA, anti-Ro/SSA and anti-La/ SSB levels positive. Materials and Methods: A prospective observational study was done in a University teaching hospital of North India (Banaras Hindu University). The study duration was between January 2014 to December 2016 and 9 cases of SLE were identified and diagnosed. All these patients were tested for ANA, anti-Ro/SSA and anti- La/SSB antibodies, were found to be positive. Three fetuses had confirmed fetal heart rate abnormalities/congenital heart block. Our neonatologist treated fetuses with heart block as per their protocols. Mothers were counseled regarding recurrence of congenital heart block in the next pregnancy. Results: All patients of SLE were positive for ANA, and had anti-Ro/ SSA- and anti-La/SSB-positive status. Three fetuses/neonate had congenital heart block, and one fetus required pacemaker after delivery. Conclusions: Delivery should be organized in tertiary referral center and with multidisciplinary care. Treatment with pacemaker insertion is life saving. These fetuses can be salvaged if they are given proper care although couple should be explained the prognosis. Keyword: Systemic Lupus Erythematous, Autoantibodies, Congenital heart block, Anti-Ro, anti-La, ANA, DSDNA, Lupus nephritis.