| Failure of intravenous immunoglobulin to prevent congenital heart block: Findings of a multicenter, prospective, observational study. | |
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MedLine Citation:
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PMID: 20131278 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Congenital heart block (CHB) is presumed to be caused by transplacental passage of maternal immunoglobulin against Ro and La ribonucleoproteins. The recurrence rate in subsequent pregnancies following the birth of a child with CHB is approximately 19%. The purpose of this study was to determine whether intravenous immunoglobulin (IVIG) therapy could prevent the development of CHB in the fetuses of high-risk pregnant women. METHODS: A total of 24 pregnancies in 22 women who had a previous pregnancy in which CHB developed, were over the age of 18 years, were <12 weeks pregnant, and had anti-Ro, anti-La, or both antibodies were monitored in this multicenter, prospective, observational study. Fifteen patients received infusions of IVIG. The 9 pregnancies in the remaining 7 patients served as controls. IVIG was administered at a dose of 400 mg/kg at weeks 12, 15, 18, 21, and 24 of pregnancy. Echocardiograms were performed at least every 3 weeks from week 15 to week 30 of gestation. Electrocardiograms were obtained at birth. The outcome measure was the development of third-degree CHB detected by fetal echocardiogram. RESULTS: CHB developed in 3 babies among the 15 pregnancies in the treatment group (20%) and in 1 baby among the 9 pregnancies in the control group (11%). CHB was detected at weeks 18, 23, and 26, respectively, in the 3 babies in the treated group and at week 19 in the baby in the control group. Three of the affected pregnancies ended in termination; 2 for reasons related to the fetal disease and 1 for reasons related to both maternal (severe pulmonary hypertension) and fetal disease (at 21 weeks of gestation). CONCLUSION: IVIG at the dose and frequency used in this study was not effective as prophylactic therapy for CHB in high-risk mothers. |
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Authors:
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C N Pisoni; A Brucato; A Ruffatti; G Espinosa; R Cervera; M Belmonte-Serrano; J S?nchez-Rom?n; F G Garc?a-Hern?ndez; A Tincani; M T Bertero; A Doria; G R V Hughes; M A Khamashta |
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Publication Detail:
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Type: Journal Article; Multicenter Study |
Journal Detail:
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Title: Arthritis and rheumatism Volume: 62 ISSN: 1529-0131 ISO Abbreviation: Arthritis Rheum. Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-04-14 Completed Date: 2010-05-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0370605 Medline TA: Arthritis Rheum Country: United States |
Other Details:
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Languages: eng Pagination: 1147-52 Citation Subset: AIM; IM |
Affiliation:
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St. Thomas' Hospital, and King's College London, London, UK. ceciliapisoni@gmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Autoantigens
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immunology Continental Population Groups Dexamethasone / therapeutic use Drug Therapy, Combination Female Heart Block / prevention & control* Heart Defects, Congenital / immunology*, prevention & control Humans Hydroxychloroquine / therapeutic use Immunoglobulins, Intravenous / therapeutic use* Infant Infant, Newborn Prednisone / therapeutic use Pregnancy Prospective Studies Recurrence Ribonucleoproteins / immunology Treatment Failure* |
| Chemical | |
Reg. No./Substance:
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0/Autoantigens; 0/Immunoglobulins, Intravenous; 0/Ribonucleoproteins; 0/SS-A antigen; 0/SS-B antigen; 118-42-3/Hydroxychloroquine; 50-02-2/Dexamethasone; 53-03-2/Prednisone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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