Session Information
Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Pediatric Systemic Lupus Erythematosus
Session Type: Abstract Submissions (ACR)
Background/Purpose
Neonatal lupus erythematosus (NLE) is a passively transferred autoimmune disease that occurs in babies born to pregnant women with anti-Ro and anti-La antibodies. The most serious complication of NLE is congenital heart block (CHB). In pregnancies of women with a known autoimmune condition and positive anti-Ro antibodies, the incidence of CHB is approximately 1-2% of live births. We have previously shown that only pregnant women with moderate-high titre of antibodies were at risk to deliver a child with CHB. However, the rate of anti-Ro antibody positive pregnant women in an otherwise healthy population is unknown as is their risk for delivering a child with CHB.
Objectives:
1) Determine the rate of anti-Ro/La antibodies in the general pregnant population.
2) Determine if the incidence of CHB is increased in healthy pregnant women with positive Ro/La antibodies compared to pregnant women with known autoimmune disease and positive anti-Ro/La antibodies
Methods
Antibody testing was performed on 15198 pregnant women who were having concurrent Maternal Serum Screening in the Metropolitan Toronto area. Maternal self-reported outcomes of prenatal, pregnancy, and post-natal medical conditions were reported, along with fetal outcomes of pre and post-natal illnesses. Autoantibody titres were stratified into negative, low, moderate, and high positive.
Results
1152/151598 (7.6%) of the pregnant women had anti-Ro antibodies and 179/15198 (1.2%) had moderate-high titres (at risk to deliver a child with CHB). 779 (5.1%) had anti-La antibodies, with the majority being low titre. During the course of the study there were 13 cases of CHB that were unrelated to our maternal sample population- 10 to well women and 2 to women with an autoimmune disease. All of these women had moderate-high titre anti-Ro antibodies, while only 31% had moderate-high titre anti-La antibodies. During the course of the study 39 pregnant women with a known autoimmune disease and anti-Ro antibodies (at risk to deliver a child with CHB) were prospectively followed. 2/39 delivered a child with CHB. Both of these women had moderate-high titre anti-Ro antibodies while 15/37 pregnant women who delivered a child without CHB had moderate-high titre anti-Ro antibodies. Therefore 2/17 (11.8%) women with moderate-high titre anti-Ro antibodies and an autoimmune disease delivered a child with CHB.
Conclusion
The incidence of CHB is reported to be between 1:10-15,000 pregnancies. Therefore, based on our data showing 1.2% of otherwise well pregnant woman had moderate-high titre anti-Ro antibodies (at risk to deliver a child with CHB), for each child with CHB we predict that 120-180 children without CHB will be delivered to otherwise healthy women, and incidence of 0.5-0.8%. In contrast, in women with a known autoimmune disease and moderate-high anti-Ro antibody titre, we found a 11.8% incidence of CHB. Therefore the risk for a woman with a known autoimmune disease and moderate-high titre anti-Ro antibodies was approximately 10x that of otherwise healthy pregnant women. These data therefore suggest that the anti-Ro antibody repertoire differs between these 2 groups of pregnant women.
Disclosure:
E. V. Rozenblyum,
None;
S. Sukhdeo,
None;
E. Jaeggi,
None;
L. Hornberger,
None;
P. Wyatt,
None;
C. A. Laskin,
None;
E. D. Silverman,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/anti-ro-and-anti-la-antibodies-in-the-general-pregnant-population/