Department of Pediatrics, University of California, Davis, Sacramento, CA, USA.
Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):9263-9270. doi: 10.1080/14767058.2022.2025536. Epub 2022 Jan 11.
Complete atrioventricular block (CAVB) is a complication of maternal antibody positivity and treatment of fetal disease is controversial in terms of efficacy and safety. We hypothesized that dexamethasone treatment for fetal anti-Ro/SSA antibody-mediated cardiac disease leads to better pregnancy outcomes than expectant management.
A retrospective multi-center cohort study of anti-Ro/SSA antibody positive pregnancies with fetal conduction disease reported by participating North American Fetal Therapy Network (NAFTNet) centers between January 2010 and December 2018. The primary outcomes included: fetal death, oligohydramnios, growth restriction, preterm delivery, and new maternal comorbidities. Secondary outcomes included: pacemaker prior to 28 days, transplantation, and neonatal death in maternal/fetal dyads treated with dexamethasone versus not.
In 127 anti-Ro/SSA positive pregnancies, 98 were treated with dexamethasone and 29 were not. Of those treated, 61/96 (63.5%) met the primary outcome including 45/91 (49.4%) premature deliveries; 20 mothers developed comorbidities during treatment (fetal death 5, 10 growth restriction, 14 oligohydramnios, two new/worsening gestational diabetes). In the untreated group, 15/25 (60%) met the primary outcome including 11/22 (50%) premature deliveries and four mothers developing comorbidities during their pregnancy (fetal death 3, one growth restriction, one new onset maternal hypertension). Regarding secondary outcomes, 37/96 (43%) treated fetuses required a pacemaker or died by 28 days, while untreated 13/25 (52%) required pacemaker placement, died prior to 28 days or required listing for transplantation. Excluding terminations, survival without transplant was 17 (68%) in untreated and 85 (89%) in treated patients (<.01).
While the use of dexamethasone in anti-Ro/SSA positive pregnancies is associated with a high rate of poor pregnancy outcomes, there was an unexpected similarly high rate in untreated positive pregnancies. This suggests that the maternal disease itself is influencing pregnancy complications independent of dexamethasone. Our data, which show that treatment decreases neonatal morbidity and overall mortality without increasing overall pregnancy complications, warrant further study.
完全性房室传导阻滞（CAVB）是母体抗体阳性的并发症，胎儿疾病的治疗在疗效和安全性方面存在争议。我们假设地塞米松治疗胎儿抗 Ro/SSA 抗体介导的心脏疾病会导致比期待治疗更好的妊娠结局。
这是一项回顾性多中心队列研究，纳入了 2010 年 1 月至 2018 年 12 月期间参与北美胎儿治疗网络（NAFTNet）的中心报告的抗 Ro/SSA 抗体阳性胎儿伴传导疾病的妊娠病例。主要结局包括胎儿死亡、羊水过少、生长受限、早产和新的母体合并症。次要结局包括：与未接受地塞米松治疗的胎儿相比，接受地塞米松治疗的胎儿在 28 天前需要起搏器、移植和新生儿死亡。
在 127 例抗 Ro/SSA 阳性妊娠中，98 例接受了地塞米松治疗，29 例未接受治疗。在接受治疗的 96 例中，61/96（63.5%）出现了主要结局，包括 45/91（49.4%）早产；20 名母亲在治疗期间出现了合并症（胎儿死亡 5 例，10 例生长受限，14 例羊水过少，2 例新出现或恶化的妊娠期糖尿病）。在未接受治疗的 25 例中，15/25（60%）出现了主要结局，包括 11/22（50%）早产和 4 名母亲在妊娠期间出现合并症（胎儿死亡 3 例，1 例生长受限，1 例新发母亲高血压）。关于次要结局，96 例接受治疗的胎儿中有 37 例（43%）在 28 天前需要起搏器或死亡，而未接受治疗的 25 例中有 13 例（52%）需要放置起搏器、在 28 天前死亡或需要移植。不包括终止妊娠，未接受治疗的存活率为 17（68%），接受治疗的存活率为 85（89%）（<.01）。
虽然在抗 Ro/SSA 阳性妊娠中使用地塞米松与较高的不良妊娠结局率相关，但在未接受治疗的阳性妊娠中也出现了类似的高不良妊娠结局率。这表明母体疾病本身独立于地塞米松影响妊娠并发症。我们的数据显示，治疗可以降低新生儿发病率和总体死亡率，而不会增加总体妊娠并发症，这值得进一步研究。
