Rheumatology Advance Access published online on April 20, 2007
Rheumatology, doi:10.1093/rheumatology/kem073
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Electrocardiographic abnormalities in infants born from mothers with autoimmune diseases—a multicentre prospective study
1Allergy, Clinical immunology and Rheumatology Unit IRCCS Istituto Auxologico Italiano,2Department of Paediatrics, Fondazione Policlinico Mangiagalli,3Cardiology Unit IRCCS Istituto Auxologico Italiano and4Department of Obstetrics and Gynaecology, Fondazione Policlinico Mangiagalli, Milan,5Rheumatology Unit and6Division of Paediatrics, Spedali Civili and University of Brescia, Brescia,7Division of Rheumatology and8Department of Pediatrics, University of Padua, Padua and9Division of Internal Medicine, Niguarda Hospital10Department of Internal Medicine, University of Milan, Milan, Italy
Correspondence to:
Pier Luigi Meroni, Allergy, Clinical Immunology & Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Via Spagnoletto, 3, 20149 Milan, Italy. E-mail: pierluigi.meroni{at}unimi.it
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Abstract |
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Objectives. To assess the prevalence of congenital heart block (CHB) and electrocardiographic (ECG) abnormalities in infants of anti-Ro/SSA-positive women.
Methods. Sixty anti-Ro-positive and 36 anti-Ro-negative patients were prospectively followed before/during pregnancy and underwent weekly fetal echocardiography from 18th to 26th weeks of gestational age. Infants’ ECG and/or ECG-Holter were performed at 1, 3, 6 and 12 months. ECG of 200 consecutive neonates were used as a healthy control group.
Results. One of 61 fetuses of anti-Ro-positive mothers developed CHB (20th week); another anti-Ro-positive baby developed second degree atrioventricular (AV) block (30th week). The prevalence of transient first degree AV block detected post-natally was significantly higher in the anti-Ro-positive group, in comparison with healthy controls (P = 0.002). No differences in corrected QT (QTc) interval prolongation prevalence (
440 ms) was observed between the anti-Ro-positive and -negative groups, but both were significantly higher than that of the control population (P < 0.001). ECG-Holter showed QTc prolongation in 59% of infants of anti-Ro-positive and in 60% of infants of anti-Ro-negative mothers. Holter QTc was 470 ms in four infants of anti-Ro-positive group and two of anti-Ro-negative group. Known acquired causes of QTc prolongation were excluded.
Conclusions. This prospective study confirms the low occurrence of CHB in newborns from anti-Ro-positive mothers. ECG abnormalities (first degree AV block and QTc interval prolongation) are frequent in infants of mothers with autoimmune diseases, independently of maternal disease, autoantibody profile and treatment during pregnancy.
KEY WORDS: Anti-SSA/Ro antibodies, ECG abnormalities, Neonatal lupus, QT prolongation, Systemic autoimmune diseases
Submitted 20 December 2006;
revised version accepted 2 March 2007.
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