Routine repeated echocardiographic monitoring of fetuses exposed to maternal anti-SSA antibodies: time to question the dogma. (November 2019)

• Record Type: Journal Article
• Authors: Costedoat-Chalumeau, Nathalie; Morel, Nathalie; Fischer-Betz, Rebecca; Levesque, Kateri; Maltret, Alice; Khamashta, Munther; Brucato, Antonio
• Is Part Of: Lancet. Volume 1:Number 3(2019)
• Page Start: e187
• Page End: e193
• Publication Date: 2019-11
• Subjects: Rheumatology -- periodicals; 616.72305
• DOI: 10.1016/S2665-9913(19)30069-4
• Languages: English
• ISSNs: 2665-9913

Abstract

Summary: In around 1% of exposed pregnancies, anti-Ro/SSA and anti-La/SSB antibodies lead to congenital heart block, the main feature of neonatal lupus syndrome. As such, echocardiographic screening to detect congenital heart block, done every other week from 16 weeks to at least 24 weeks gestation, is widely recommended for anti-SSA-positive pregnant women. Such screening is now routinely done in many centres worldwide. In this Viewpoint, we call this dogma into question for several reasons. Even if congenital heart block is discovered (which is rare), the usefulness of treatment with fluorinated steroids has not been shown, whereas the associated side-effects are well known. The discovery of congenital heart block very early in the pregnancy does not modify obstetric management, and at least 500 ultrasounds are needed to find one case of congenital heart block, which would ultimately be found by other means. Finally, this screening strategy misses most cases of congenital heart block because most affected women are not known to have anti-SSA antibodies, and thus are not screened. Accordingly, except in the context of research protocols, which are certainly needed and are outside the scope of this Viewpoint, overturning the dogma of routine repeated screenings for congenital heart block could save money and health-care staff time and prevent maternal stress without substantial clinical consequences.