Vol.23 No.4

Original Article

The predictive value of anti-SS-A antibodies titration in pregnant women with fetal congenital heart block

Authors

Ai Anami1 , Kotaro Fukushima1 , Yoshinari Takasaki2 , Takayuki Sumida3 , Masako Waguri4 , Norio Wake1 , Atsuko Murashima5

  • Department of Obstetrics and Gynecology, Kyushu University Hospital, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan
  • Department of Rheumatology, School of Medicine, Juntendo University, Tokyo, Japan
  • Doctoral Programs in Clinical Science, Department of Clinical Immunology, Graduate School of Comprehensive Human Science, University of Tsukuba, Ibaraki, Japan
  • Department of Maternal Medicine, Osaka Medical Center and Research, Institute for Maternal and Child, Osaka, Japan
  • Department of Maternal Medicine, National Center for Child Health and Development, Tokyo, Japan
Received:

7 March 2012

Accepted:

13 June 2012

Published online:

4 July 2012

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Abstract

Objective Fetal congenital complete heart block (CHB) is irreversible and is associated with significant mortality and morbidity. Anti-SS-A antibodies in the maternal sera are involved in its pathogenesis; however, the predictive value of the antibody titer and its role in prediction of this complication are controversial. The aim of this study was to determine the predictive value of maternal anti-SS-A antibodies on the development of fetal CHB.
Methods A retrospective chart review was performed for 189 cases of positive anti-SS-A antibodies determined by the double immunodiffusion (DID) method, and included 17 patients that developed fetal CHB. The relationship between the appearance of CHB and the anti-SS-A antibodies titer was examined.
Results An anti-SS-A antibodies titer of 1:32 or higher was identified by analyzing the receiver-operating characteristics (area under curve 0.72) curve. An anti-SS-A antibodies titer of 32 or more times greater than the upper limit by DID was a risk factor for fetal CHB (odds ratio 27.77, 95 % confidence interval (CI) 1.91?21.02, P%ABST%.05) in the multivariate analysis. Among 107 cases of anti-SS-A antibodies titers of 1:32 or higher, 65 patients (60.7 %) were treated with oral steroids. Of these, four patients had CHB (6.2 %). This rate of CHB was significantly lower (P%ABST%.01) than the rate in patients not treated with steroids.
Conclusion An anti-SS-A antibodies titer of 1:32 or higher in the maternal sera by DID was an independent risk factor for fetal CHB. In these patients, either antenatally administered prednisolone or betamethasone, was associated with a lower risk of fetal CHB.

Key words

Connective tissue diseases, Anti-SS-A antibodies, Pregnancy