Ultrasonographic characterization and prognostic follow-up of fetal cardiac involvement in maternal immune diseases.

OBJECTIVE

To analyze the clinical characteristics, echocardiographic features, and prognosis of fetuses with maternal immune diseases.

METHODS

We retrospectively evaluated 20 fetuses with cardiac manifestations due to maternal immune diseases from our center between 2019 and 2023 in China. Clinical and echocardiographic data of fetuses and maternal sero-immunity were collected. The pregnancy outcomes were followed up.

RESULTS

The cardiac manifestations seen in 20 fetuses were categorized into three types: type I: isolated-arrhythmia: seven cases (35%); type II: isolated endocardial fibroelastosis (EFE): four cases (20%); and type III: both arrhythmia and EFE: nine cases (45%). The arrhythmias in all cases were bradyarrhythmia, including sinus bradycardia and atrioventricular block. The results of maternal antibody test showed the following three types: (1) five cases were positive for anti-SSA antibody alone; (2) 10 cases of positive for both anti-SSA and anti-SSB antibody; (3) five cases of other special types of antibodies. Ultimately, four newborns were delivered and 16 fetuses were terminated. Of the mothers who chose to induce labor, three were treated and repregnant, two of which had normal fetuses, while one had a recurrence of arrhythmia, which was treated and monitored closely during the prenatal period, resulting in normalization of the fetal heart rhythm and eventual full-term delivery.

CONCLUSION

Fetal cardiac involvement due to maternal immune diseases can be categorized into three types: the isolated-arrhythmia, isolated EFE, and both arrhythmia and EFE. In our study, all cases of arrhythmia were bradyarrhythmias, with sinus bradycardia being the most prevalent type. Given the strong association between maternal autoimmune diseases and fetal cardiac abnormalities such as bradyarrhythmias and EFE, prenatal ultrasound findings of these conditions should raise suspicion for maternal immune disorders. Consequently, prompt screening for maternal autoimmune antibodies is recommended.