Document Detail


Failure of intravenous immunoglobulin to prevent congenital heart block: Findings of a multicenter, prospective, observational study.
MedLine Citation:
PMID:  20131278     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  62     ISSN:  1529-0131     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-14     Completed Date:  2010-05-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1147-52     Citation Subset:  AIM; IM    
Affiliation:
St. Thomas' Hospital, and King's College London, London, UK. ceciliapisoni@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Autoantigens / 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:
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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