Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Third degree atrioventricular block(AVB), a rare congenital complication, duplicate-triplicate frequency up to 2% when Ro/La maternal antibodies are present. Incidence rises to 17-20% in mothers with a previous child with AVB. Maternal consumption of hydroxychloroquine seems to reduce this risk. The purpose was to evaluate the incidence of fetal AVB and its relationship with the consumption of hydroxychloroquine in women with Ro/La antibodies whose pregnancies have been followed at our hospital.
Methods: We reviewed the electronic medical records from years 2000 to 2014 of a) all pregnant women with known Ro/La antibodies, b) all pregnant women with hydroxychloroquine consumption in the pharmacy registry and c) all mothers of children younger than 2 years old with AVB and/or pacemaker placement.
Results: 62 pregnancies in 47 mothers with Ro/La antibodies were identified. Pregnant women who had consumed hydroxychloroquine during all the pregnancy (n=14) were compared with those who had not(n=48). Demographic characteristics are shown in table 1. One newborn (7.1%) suffered a AVB in the hydroxychloroquine group versus 7 newborn in the group without hydroxychloroquine (14.6%)(p=0.5). None of the mothers had more than one pregnancy with AVB. AVB was detected at a median gestational age of 20 weeks and they were all intrauterine (table 2). Between 2000 and 2014, 23 AVB were diagnosed on children younger than 2 years old, 10 of them were associated with the presence of antibodies and/or a maternal rheumatologic disease. 3 of these children (30%) required the collocation of a pacemaker before 2 years of age and 2 children (20%) died before a pacemaker could be implanted. The other 13 (10 followed up for more than 2 years) congenital AVB were associated to congenital structural heart disease and 100% required a pacemaker implantation (p<0.001 versus AVB without structural heart disease)(table 2).
Conclusion: A high incidence of AVB in patients with Ro/La antibodies in our hospital was observed (12.9 %), perhaps due to derivation bias. Although AVB was more frequent in mothers without hydroxychloroquine (14.6% versus 7.1%), the difference was not statistically significant. All congenital AVB diagnosed at our hospital without structural heart disease were associated with a rheumatic disease or presence of maternal antibodies. Table 1: Pregnancy characteristics of women with Ro/La antibodies
| Women with Ro/La antibodies treated with Hydroxychloroquine during pregnancy(n=14) | Women with Ro/La antibodies without Hydroxychloroquine during pregnancy(n=48) | P value | |
| Maternal age at the time of pregnancy, mean(SD) | 34.1 (3.3) | 34.6 (4.8) | 0.7 |
| Ro +, % (95% CI) | 100 | 93.8 ( 86.6-100) | 0.34 |
| La +, % (95% CI) | 42.9 (13.2-72.5) | 50 (35.3-64.7) | 0.64 |
| Antiphospholipid syndrome % (95% CI) | |||
| – Lupus anticoagulant | 7.1 (8.2-22) | 0 | 0.07 |
| – Anticardiolipins | 21.4 (3.1-46) | 4.2 (1.7-100) | 0.04 |
| Maternal rheumatologic disease, n | |||
| – Systemic lupus erithematosus | 11 | 8 | <0.001 |
| – Sjogren | 3 | 16 | 0.52 |
| – Mixed connective tissue disease | 0 | 5 | 0.58 |
| – Rheumatoid arthritis | 0 | 4 | 0.57 |
| – Scleroderma | 0 | 2 | 1 |
| – Polychondritis | 0 | 1 | 1 |
| – Unknown maternal diagnosis | 0 | 12 | 0.052 |
| Pregnancy outcomes: % (95%CI) | |||
| – Abortion | 14.3 (-6.7-35.3) | 4.2 (-1.7-100) | 0.18 |
| – Fetal death | 0 | 2.1 (-2.1-6.3) | 0.59 |
| – Live newborn | 85.7 (64.7-106) | 93.8 (86.6-100) | 0.33 |
| Fetal complications: % (95%CI) | |||
| – Intrauterine growth restriction | 14.3 (6.7-35.3) | 6.3 (-0.8-13.4) | 0.31 |
| – Preterm | 0 | 0 | |
| – AVB | 7.1 (1.8-33.9) | 14.6 ( 6.1-27.8) | 0.5 |
| – Neonatal complications | 0 | 0 | |
| – Neonatal cutaneous lupus | 0 | 0 | |
| Maternal complications: % (95%CI) | |||
| – Pre-eclampsia | 21.4 (-3.1-46) | 8.3 (0.2-16.4) | 0.17 |
| – Eclampsia | 0 | 0 | |
| – Gestational diabetes | 0 | 0 | |
| – Gestational hypertension | 7.1 (1.8-33.9) | 4.2 (0.51-14.2) | 0.54 |
| Treatment during pregnancy: % (95% CI) | |||
| – Aspirine | 28.6 (1.5-55.6) | 4.2 (-1.7-10 ) | 0.007 |
| – Glucocorticoids | 28.6 (1.5-55.6) | 10.4 ( 1.5-19.4) | 0.09 |
| – Azathioprine | 14.3 (-6.7-35.3) | 0 | 0.008 |
| Pregnancy duration, weeks, median (IQR) | 36.5 (35-38) | 38 (35-39) | 0.12 |
| Hospital follow up, years, median (IQR) | 9.1 (4.8-12.8) | 9.1 (5-10.5) | 0.47 |
Table 2: Newborn AVB before 2 years of age
| AVB with structural heart disease (n=13) | AVB without structural heart disease (n=10) | P value | |
| Mother with Ro antibodies, n/tested (%) | 0 | 8/8 (100) | 0.0001 |
| Mother with La antibodies, n/tested (%) | 0 | 7/8 (87,5) | <0.0001 |
| Neonatal death | 0 | 1 (10) | 0.2437 |
| Pacemaker requirement before 2 years of age, n (%) | 13 (100%) | 3 (30%) | <0.001 |
| Death before 2 years of age, n (%) | 4/10 (40%) | 2/10 (20%) | 0.34 |
| Gestational age at the time of AVB, median (IQR) | —- | 20 (20-25) | |
| PostnatalAVB, n (%) | 13 (100%) | 0 | <0.0001 |
| Pregnancy duration, median (IQR) | 38 (37-38) | 37 (35-37) | 0.08 |
To cite this abstract in AMA style:
Mollerach FB, Scolnik M, Catoggio LJ, Soriano ER. Cohort of Pregnant Women with Ro/La Antibodies: Risk of Fetal Third Degree Atrioventricular Block and Use of Hydroxychloroquine [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/cohort-of-pregnant-women-with-rola-antibodies-risk-of-fetal-third-degree-atrioventricular-block-and-use-of-hydroxychloroquine/. Accessed .« Back to ACR/ARHP Annual Meeting 2016
ACR Meeting Abstracts - https://acrabstracts.org/abstract/cohort-of-pregnant-women-with-rola-antibodies-risk-of-fetal-third-degree-atrioventricular-block-and-use-of-hydroxychloroquine/