Fetal echocardiographic surveillance in anti-SSA/Ro-SSB/La-Positive systemic lupus erythematosus pregnancies: risk stratification of congenital heart block

Objective To evaluate the clinical utility of serial fetal echocardiographic surveillance, specifically atrioventricular interval (AVI) monitoring, in managing Anti-SSA/Ro-SSB/La-Positive systemic lupus erythematosus (SLE) pregnancies. Methods SLE pregnancies with positive anti-SSA/Ro-SSB/La antibodies were retrospectively included (n = 50). Pregnancies were stratified into two groups based on based on whether optimal pre-gestational conditions were met. All pregnancies underwent serial fetal echocardiography, including structural assessment and precise AVI measurement. Results The overall incidence of fetal cardiac conduction abnormalities was 12% (6/50). The incidence was significantly higher in the suboptimal-conditions group (group 2, 26% [5/19]) compared with the optimal-conditions group (group 1, 3% [1/31]) (p = 0.024). Through close monitoring, one fetus with persistent AVI prolongation received dexamethasone and intravenous immunoglobulin, successfully preventing progression to advanced heart block; the other five cases normalized spontaneously upon short-term follow-up, avoiding overtreatment. Conclusion SLE pregnancies with anti-SSA/Ro-SSB/La antibodies and suboptimal gestational conditions constitute a distinct high-risk subgroup. A management strategy through risk-stratified serial fetal AVI monitoring allows for precise treatment identification, significantly improving neonatal outcomes while avoiding unnecessary interventions.