Serial echocardiography for immune-mediated heart disease in the fetus: results of a risk-based prospective surveillance strategy.

ObjectiveMothers carrying anti-Ro antibodies are frequently referred for weekly echocardiograms to early detect and treat antibody-mediated fetal heart disease. We tested a surveillance strategy based on anti-Ro antibody titers. MethodsFrom 2009 to 2014, 232 pregnancies were referred for maternal anti-Ro antibodies. At the baseline echocardiogram, anti-Ro titers were measured by enzyme-linked immunosorbent essay and results categorized as negative (<8U/mL; n=43; excluded), low-moderate positive (8-49U/mL; n=62; group 1) or high positive (50 - >100U/mL; n=127; group 2). Serial echocardiograms to 24weeks were only recommended for group 2 mothers. ResultsGroup 1 patients underwent significantly less fetal echocardiograms when compared with group 2 mothers (median 2 vs. 4; p<0.001). Isolated endocardial fibroelastosis (n=1) and incomplete (n=4) or complete (n=4) heart block were diagnosed in 9 (8%) pregnancies with anti-Ro titers >100U/mL but none with lower titers (odds ratio 17.78; p=0.004). Incomplete block and endocardial fibroelastosis regressed with transplacental corticosteroid and immune globulin therapy. ConclusionsLimiting serial fetal echocardiograms to women with high anti-Ro antibody levels is safe and more cost effective. While numbers of echocardiograms were significantly reduced in referrals with anti-Ro titers <50U/mL, reversible abnormalities with prenatal treatment were detected by serial echocardiography in group 2 patients. (c) 2017 John Wiley & Sons, Ltd.