Maternal autoimmune disease and its impact on the fetal heart: Management and prognosis

Abstract

Congenital complete atrioventricular heart block, myocarditis and endocardial fibroelastosis related to maternal anti-Ro and anti-La autoantibodies have been associated with a significant mortality, with most deaths occurring in utero or during infancy. Transplacental treatment with fluorinated steroids, in combination with β-mimetics at heart rates < 55 beats/min, has significantly improved the survival rate of affected patients in recent years. Severe fetal hyperthyroidism is a rare pregnancy condition that is induced by maternal thyroid stimulating antibodies. Persistent sinus tachycardia of > 160 beats/min is a clinical hallmark. Treatment with propylthiouracil and a β-blocker aims at inhibiting fetal thyroid hormone synthesis and controlling the fetal heart rate. Insulin-dependent maternal diabetes mellitus is associated with an increased incidence of cardiac malformations, including conotruncal lesions. Mild and reversible ventricular hypertrophy is common even in well-controlled maternal diabetes, without affecting the age-related changes in cardiac function.