Immune-mediated Congenital Heart Block (CHB): identifyingand counseling patients at risk for having children with CHB
| Autor: | Harry Holthöfer, Pekka Kurki, Peter Maddison, Sirén Mk, Chris Mack, Susan McCready, Risto Kaaja, Julkunen H |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Adult
Counseling Male medicine.medical_specialty Heart block Enzyme-Linked Immunosorbent Assay Autoantigens 03 medical and health sciences 0302 clinical medicine Rheumatology Antibody Specificity Pregnancy Recurrence Risk Factors Immunopathology RNA Small Cytoplasmic Prevalence medicine Humans Risk factor Child Fetal Death Finland Autoantibodies Retrospective Studies 030203 arthritis & rheumatology 030219 obstetrics & reproductive medicine Lupus erythematosus business.industry Obstetrics Incidence Pregnancy Outcome Autoantibody medicine.disease Connective tissue disease 3. Good health Abortion Spontaneous Heart Block Anesthesiology and Pain Medicine Ribonucleoproteins El Niño Relative risk Immunology Female business |
| Zdroj: | Seminars in Arthritis and Rheumatism. 28:97-106 |
| ISSN: | 0049-0172 |
| DOI: | 10.1016/s0049-0172(98)80042-5 |
| Popis: | Objective: To identify patterns of maternal antibodies associated with anincreased risk of having a child with congenital heart block (CHB) and to provide a basis for counseling women with a previously affected child. Methods: This retrospective clinical study of the obstetric histories of 46Finnish women with a CHB child compared the strength and specificity of the immune response to SS-A/Ro and SS-B/La, as determined by immunoblot and ELISA, in 44 affected women with 85 women with systemic lupus erythematosus (SLE) and 32 women with primary Sjogren's syndrome (SS) with healthy children. Results: High levels of anti-SS-A/Ro and anti-SS-B/La by practically all assays were associated with a significantly increased risk of having a CHB child. The best single test to identify high-risk mothers was anti-52kd SS-A/Ro by immunoblot (OR 18.9), and it was the only assay to detect mothers at increased risk of CHB as compared with controls with primary SS. Low risk of CHB was indicated by undetectable or low levels of antibodies in the ELISA assays and no reactivity on immunoblot. Mothers with a previous child with CHB had a history of fetal loss (mostly spontaneous abortions) or a history of recurrent fetal losses (⪖3) slightly more often than controls. Late-trimester obstetric complications in non-CHB pregnancies were insignificant. The relative risk for a female child compared with a male child to have CHB was 1.9 (1.2-2.9, P = .009), and the risk of the mother having another child with CHB was 12% (4 of 34). Conclusion: Although there is no unique antibody profile specific for CHB, mothers with a high or low risk of having a child with CHB can be identified. Female children appear to have an increased risk of CHB, but the risk of the mother having another child with CHB is low. |
| Databáze: | OpenAIRE |
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