Arrhythmias and conduction disturbanceProspective Evaluation of Fetuses With Autoimmune-Associated Congenital Heart Block Followed in the PR Interval and Dexamethasone Evaluation (PRIDE) Study
Section snippets
Methods
Patients entered this prospective, multicenter, observational study from December 2000 to April 2006. A total of 40 pregnant women with anti-SSA/Ro antibodies (with/without anti-SSB/La antibodies) were enrolled from 33 centers across the United States by participating clinicians who included rheumatologists, pediatric cardiologists, and obstetricians. The study was approved by the IRB of the New York University School of Medicine (New York, New York). Written informed consent was obtained from
Results
Forty mothers identified with a fetus with CHB were enrolled. Maternal health status was as follows: 11 women were asymptomatic, 10 had SS, 6 had SLE, 1 had SLE/SS, 1 had discoid lupus, 10 had UAS, and 1 had rheumatoid arthritis. Recurrent fetal disease was common: 4 women (10%) had a previous offspring with CHB, and 5 women (13%) had a previous infant with the characteristic rash of neonatal lupus. All mothers with a previously affected child were in the DEX group.
Thirty of these mothers
Discussion
This component of the PRIDE study2 comprises prospective observational data obtained with the use of a structured protocol including serologic confirmation and echocardiographic oversight from 40 fetuses diagnosed with CHB. Confirming and extending published studies, once fetal third-degree block was detected, it was irreversible, regardless of treatment with DEX.1 Moreover, second-degree block progressed to third-degree block despite DEX treatment, as previously reported.10 This study also
Acknowledgment
We thank the following investigators for contributing to the PRIDE study: Matthew Allsede, MD, Ahmed Baschat, MD, Tara Becker, MD, T.M. Biancaniello, MD, Morton Borg, MD, Patrick Callahan, MD, Eric J. Carlson, MD, Edward Chien, MD, Kathryn Collins, MD, Bettina F. Cuneo, MD, William Cusick, MD, Curt DeGroff, MD, Mary Donofrio, MD, Robin Doroshow, MD, James F.X. Egan, MD, Mohammed Elkousy, MD, Llyod Feit, MD, Carlen Gomez, MD, Nina Gotteiner, MD, Julie Glickstein, MD, David Hirsch, MD, Eby
References (20)
- et al.
The fetal PR interval: pulsed Doppler echocardiographic assessment
Am J Cardiol
(2000) - et al.
Validation of the Doppler PR interval in the fetus
J Am Soc Echocardiogr
(2002) - et al.
Cellular rejection of conduction system after orthotopic heart transplantation for congenital atrioventricular block
J Heart Lung Transplant
(2006) - et al.
In vitro metabolism of prednisolone, dexamethasone, betamethasone, and cortisol by the human placenta
Am J Obstet Gynecol
(1977) - et al.
Comparison of treatment with fluorinated glucocorticoids to the natural history of autoantibody associated congenital heart block
Arthritis Rheum
(1999) - et al.
Utility of cardiac monitoring in fetuses at risk for congenital heart block: The PR Interval and Dexamethasone Evaluation (PRIDE) prospective study
Circulation
(2008) - et al.
The 1982 revised criteria for the classification of systemic lupus erythematosus
Arthritis Rheum
(1982) - et al.
Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American–European Consensus Group
Ann Rheum Dis
(2002) - et al.
The fetal Doppler mechanical PR interval: a validation study
Fetal Diagn Ther
(2004) - et al.
Maternal antibody responses to the 52-kd SSA/RO p200 peptide and the development of fetal conduction defects
Arthritis Rheum
(2005)
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This work was funded by Grant RO1 AR42455-01 (Maternal Autoantibodies: Pathogenesis of Neonatal Lupus) from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (Bethesda, Maryland) to Dr. Buyon, Contract NO1-AR-4-2220 (Research Registry for Neonatal Lupus) from the National Institutes of Health to Dr. Buyon, Grant 1-R01-AR46265 (the PRIDE study) from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases to Dr. Buyon, and a generous gift from the Lee family, Brooklyn, New York.