Fredi Micaela, Argolini Lorenza Maria, Angeli Fabrizio, Trespidi Laura, Ramoni Veronique, Zatti Sonia, Vojinovic Tamara, Donzelli Davide, Gazzola Federica Giulia, Xoxi Blerina, Andreoli Laura, Lojacono Andrea, Ferrazzi Enrico, Montecucco Carlomaurizio, Chighizola Cecilia Beatrice, Meroni Pier Luigi, Franceschini Franco, Cimaz Rolando, Caporali Roberto, Tincani Angela, Gerosa Maria
Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy.
Division of Clinical Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy.
Clin Exp Rheumatol. 2023 Mar;41(3):685-693. doi: 10.55563/clinexprheumatol/2ju0yv. Epub 2022 Nov 12.
Neonatal lupus (NL) is an acquired disease caused by the transplacental passage of anti-SSA/Ro antibodies. The rate of congenital heart block (CHB), its most serious manifestation, ranges from 1 to 5%. The aim of this study was to retrospectively assess the prevalence of CHB in anti-SSA/Ro positive pregnant women with or without systemic autoimmune diseases from 2010 to 2020.
Patients underwent monthly visit and a shared follow-up programme of weekly (16th-24th week) foetal heart rate assessment by obstetric ultrasound.
322 pregnancies in 258 anti-SSA/Ro patients were included; 314 were followed from the beginning of pregnancy because of the known presence of anti-SSA/Ro autoantibodies and 1 case of CHB occurred in an anti-SSA/Ro+ asymptomatic subject (0.3%). In the same period, 8 additional patients were referred to our clinics after in utero CHB diagnosis and subsequent discovery of anti-SSA/Ro without a disease diagnosis. Globally, 9 cases of congenital CHB (2.8%) occurred: 7 complete, 1 II-III degree and 1 rst degree CHB. Anti-SSB/La positivity was associated with a higher risk of CHB (7.8% vs. 1.2%; p=0.0071). No differences in maternal or foetal outcomes were found in comparison with a large cohort of unselected pregnancies except for caesarian section. Hydroxychloroquine (HCQ) was used in 58.3% pregnancies, with a different prevalence according with maternal diagnosis.
Our data suggest that anti-SSA/Ro positive patents with a de ned systemic autoimmune disease undergoing a strict follow-up since positive pregnancy test display a low risk of pregnancy complications, including but not limited to NL.
新生儿狼疮（NL）是一种由抗SSA/Ro抗体经胎盘传递引起的后天性疾病。其最严重的表现形式——先天性心脏传导阻滞（CHB）的发生率为1%至5%。本研究的目的是回顾性评估2010年至2020年期间抗SSA/Ro阳性且患有或未患有系统性自身免疫性疾病的孕妇中CHB的患病率。
患者每月就诊一次，并通过产科超声进行每周一次（孕16至24周）的胎儿心率评估的共享随访计划。
纳入了258例抗SSA/Ro患者的322次妊娠；314例因已知存在抗SSA/Ro自身抗体而从妊娠开始就进行了随访，1例CHB发生在一名抗SSA/Ro阳性无症状受试者中（0.3%）。同期，另有8例患者在宫内CHB诊断及随后发现抗SSA/Ro但无疾病诊断后转诊至我们的诊所。总体上，发生了9例先天性CHB（2.8%）：7例完全性、1例二度至三度和1例一度CHB。抗SSB/La阳性与CHB风险较高相关（7.8%对1.2%；p = 0.0071）。与一大群未选择的妊娠相比，除剖宫产外，母婴结局无差异。58.3%的妊娠使用了羟氯喹（HCQ），其患病率因母亲诊断而异。
我们的数据表明，自妊娠试验呈阳性起就接受严格随访的患有明确系统性自身免疫性疾病的抗SSA/Ro阳性患者发生妊娠并发症（包括但不限于NL）的风险较低。
