Fetal heart rate monitoring feasible, accurate in anti-Ro/SSA antibody positive pregnancy
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Heart rate monitoring may be a crucial means of detecting rhythm abnormalities in the fetuses of pregnant individuals who are positive for anti-Ro/SSA antibodies, according to data presented at ACR Convergence 2021.
“The importance of monitoring is to find early conduction disease that may be reversible with treatment since complete congenital heart block (CHB) can be fatal,” Jill P. Buyon, MD, of New York University Langone Health, told Healio Rheumatology. “This is a disease that can affect the pregnancy of any mother who has anti-Ro antibodies, including those who have no clinical disease. The really interesting aspect of these antibodies is that they can be detected in about 1 in 100 totally healthy women, 40% of women with lupus and up to 100% of women with Sjogren’s syndrome.”
“What this means is that even healthy mothers are at risk for having a baby with congenital heart block,” she added. “But the frequency of CHB is rare — 2% if the individual never had a child with CHB, and an 18% recurrence rate not related to the maternal health, just the presence of anti-Ro antibodies. Some women find out about anti-Ro only because, sadly, the baby has CHB.”
To analyze the feasibility, acceptance and accuracy of the fetal heart rate and rhythm technique in high-risk pregnant individuals, Buyon and colleagues recruited participants from the Surveillance to Prevent AV Block Likely to Occur Quickly (STOP BLOQ) study. Specifically, the researchers enrolled 56 pregnant individuals who were commercially positive for anti-Ro/SSA antibodies. Among these participants, 37 with anti-Ro60 or anti-Ro52 antibodies at or above 1,000 IU, or a previous child with CHB, were trained to perform the fetal heart rate and rhythm technique using an educational video and personal instruction from a pediatric cardiologist.
Participants completed the technique three times per day from gestation week 17 to week 25. Weekly or biweekly fetal echocardiograms were also performed. Participants sent audiotexts of all fetal monitoring sounds to the researchers’ coordinating center. Sounds deemed abnormal by the participants were forwarded to an on-call pediatric cardiologist, who then assessed the situation and, if confirmed as abnormal, referred the patient for an emergency fetal echocardiogram within less than 6 hours. The researchers also assessed postnatal electrocardiograms for CHB.
In all, Buyon and colleagues received 3,360 audiotexts during the monitoring period. Among these, 39 recordings from five concerned participants triggered an immediate call with the on-call pediatric cardiologist. According to the researchers, all but two recordings were deemed to be normal based on a review of the audiotext alone.
In the two emergency cases, an echocardiogram was completed in less than 6 hours, which revealed premature atrial contractions in both, confirming the initial perception of abnormality from the fetal heart rate and rhythm technique. However, there was no evidence of conduction disease. All surveillance echocardiograms were normal, meaning the overall rate of false positive recordings for the concern of a conduction defect perceived by the participants was 1.1% — or 38 out of 3,360. There were no reports of CHB at birth.
“If the CHB is found to be third degree — or complete — it cannot be reversed,” Buyon said. “But if detected at an earlier stage there may be a chance of reversal. It is hoped that this inexpensive monitoring that can be done by the mother, at home or at work, and will detect early and reversible block. We are teaching the mothers how to listen and, in the future, hope that the device will be programmed to automatically identify an abnormality.”
“Women with anti-Ro antibodies can do this surveillance,” she added. “It may prevent irreversible block and may make the need for frequent costly and time-consuming echocardiograms to be needed much less frequently.”
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Masson M. Abstract 1464. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
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