OBJECTIVE: Congenital heart block (CHB) is presumed to be caused by transplacental passage of maternal immunoglobulin against Ro and La ribonucleoproteins. The recurrence rate in subsequent pregnancies following the birth of a child with CHB is approximately 19%. The purpose of this study was to determine whether intravenous immunoglobulin (IVIG) therapy could prevent the development of CHB in the fetuses of high-risk pregnant women. METHODS: A total of 24 pregnancies in 22 women who had a previous pregnancy in which CHB developed, were over the age of 18 years, were <12 weeks pregnant, and had anti-Ro, anti-La, or both antibodies were monitored in this multicenter, prospective, observational study. Fifteen patients received infusions of IVIG. The 9 pregnancies in the remaining 7 patients served as controls. IVIG was administered at a dose of 400 mg/kg at weeks 12, 15, 18, 21, and 24 of pregnancy. Echocardiograms were performed at least every 3 weeks from week 15 to week 30 of gestation. Electrocardiograms were obtained at birth. The outcome measure was the development of third-degree CHB detected by fetal echocardiogram. RESULTS: CHB developed in 3 babies among the 15 pregnancies in the treatment group (20%) and in 1 baby among the 9 pregnancies in the control group (11%). CHB was detected at weeks 18, 23, and 26, respectively, in the 3 babies in the treated group and at week 19 in the baby in the control group. Three of the affected pregnancies ended in termination; 2 for reasons related to the fetal disease and 1 for reasons related to both maternal (severe pulmonary hypertension) and fetal disease (at 21 weeks of gestation). CONCLUSION: IVIG at the dose and frequency used in this study was not effective as prophylactic therapy for CHB in high-risk mothers.
OBJECTIVE:Congenital heart block (CHB) is presumed to be caused by transplacental passage of maternal immunoglobulin against Ro and La ribonucleoproteins. The recurrence rate in subsequent pregnancies following the birth of a child with CHB is approximately 19%. The purpose of this study was to determine whether intravenous immunoglobulin (IVIG) therapy could prevent the development of CHB in the fetuses of high-risk pregnant women. METHODS: A total of 24 pregnancies in 22 women who had a previous pregnancy in which CHB developed, were over the age of 18 years, were <12 weeks pregnant, and had anti-Ro, anti-La, or both antibodies were monitored in this multicenter, prospective, observational study. Fifteen patients received infusions of IVIG. The 9 pregnancies in the remaining 7 patients served as controls. IVIG was administered at a dose of 400 mg/kg at weeks 12, 15, 18, 21, and 24 of pregnancy. Echocardiograms were performed at least every 3 weeks from week 15 to week 30 of gestation. Electrocardiograms were obtained at birth. The outcome measure was the development of third-degree CHB detected by fetal echocardiogram. RESULTS: CHB developed in 3 babies among the 15 pregnancies in the treatment group (20%) and in 1 baby among the 9 pregnancies in the control group (11%). CHB was detected at weeks 18, 23, and 26, respectively, in the 3 babies in the treated group and at week 19 in the baby in the control group. Three of the affected pregnancies ended in termination; 2 for reasons related to the fetal disease and 1 for reasons related to both maternal (severe pulmonary hypertension) and fetal disease (at 21 weeks of gestation). CONCLUSION: IVIG at the dose and frequency used in this study was not effective as prophylactic therapy for CHB in high-risk mothers.
Authors: Peter M Izmirly; Nathalie Costedoat-Chalumeau; Cecilia N Pisoni; Munther A Khamashta; Mimi Y Kim; Amit Saxena; Deborah Friedman; Carolina Llanos; Jean-Charles Piette; Jill P Buyon Journal: Circulation Date: 2012-05-24 Impact factor: 29.690
Authors: Carolina Llanos; Deborah M Friedman; Amit Saxena; Peter M Izmirly; Chung-E Tseng; Renata Dische; Rosanna G Abellar; Marc Halushka; Robert M Clancy; Jill P Buyon Journal: Rheumatology (Oxford) Date: 2012-02-03 Impact factor: 7.580
Authors: Megan E B Clowse; Amanda M Eudy; Elizabeth Kiernan; Matthew R Williams; Bonnie Bermas; Eliza Chakravarty; Lisa R Sammaritano; Christina D Chambers; Jill Buyon Journal: Rheumatology (Oxford) Date: 2018-07-01 Impact factor: 7.580
Authors: John G Routsias; Nikolaos C Kyriakidis; Deborah M Friedman; Carolina Llanos; Robert Clancy; Haralampos M Moutsopoulos; Jill Buyon; Athanasios G Tzioufas Journal: Arthritis Rheum Date: 2011-09
Authors: Robert M Clancy; Androo J Markham; Tanisha Jackson; Sara E Rasmussen; Miroslav Blumenberg; Jill P Buyon Journal: Am J Physiol Heart Circ Physiol Date: 2017-06-16 Impact factor: 4.733