Serial echo recommended in some lupus pregnancies: small risk of congenital heart block present.(News)

NEW YORK -- Exposure to maternal lupus autoantibodies confers a risk of congenital heart block and neonatal lupus on the fetus, but the risk is small, and no medical treatment is currently recommended, Jill P. Buyon, M.D., said at a meeting sponsored by the Lupus Foundation of America.

Women who are positive for anti-SSA/Ro and anti-SSB/La autoantibodies have a baseline 2% chance that fibrosis of the atrioventricular node and heart block will develop in the fetus, but that risk increases 10-fold if they have had a previous child with either heart block or a facial rash, she said.

These statistics have emerged from the ongoing Research Registry for Neonatal Lupus, which now includes more than 300 women. The registry is sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and is directed by Dr. Buyon, professor of medicine and vice chairman of the department of rheumatology, New York University, New York City.

Thus far, 94 women in the registry have become pregnant and given birth after having had a child with heart block, and 67 of these babies have been healthy. Among the infants with manifestations of neonatal lupus, 15 had congenital heart block only, three had heart blocks plus a rash, and seven had the rash alone. There was one fetal demise and one neonatal death.

Clearly, women who have had a child with heart block or a neonatal rash should be followed carefully. "Our recommendation is to begin serial echocardiographic monitoring at 16 weeks, doing it weekly until week 28 if feasible and then every other week until [week] 32," she said. The timing and frequency are important because the fibrosis of congenital heart block develops very quickly, and almost always occurs between weeks 18 and 23, she ...