Association between maternal anti-Ro and anti-La antibody levels and congenital heart block: a 20-year cohort study

Q: What are the key findings of this study?

Higher maternal anti-Ro and anti-La antibody levels were significantly associated with fetal congenital heart block, with median anti-Ro levels of 240 in affected versus 42 in unaffected pregnancies.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Pregnancy with positive anti-Ro and/or anti-La antibodies (n=182). Intervention: Maternal anti-Ro and anti-La antibodies vs. Lower maternal antibody levels. Primary outcome: Median maternal anti-Ro antibody levels in pregnancies with fetal congenital heart block (p=<0.001).

Q: What question did this study set out to answer?

To evaluate the association between maternal anti-Ro and anti-La antibody levels and the occurrence of congenital heart block in fetuses and newborns.

Gabriel Duque Pannain; Joelma Queiroz Andrade; Marco Antônio Borges Lopes; Fabrício Marcondes Camargo; Vera Lúcia Jornada Krebs; Werther Brunow de Carvalho; Rossana Pulcinelli Vieira Francisco

doi:10.1007/s00404-026-08360-z

February 21, 2026Archives of Gynecology and ObstetricsOpen Access

Association between maternal anti-Ro and anti-La antibody levels and congenital heart block: a 20-year cohort study

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Key result

Higher maternal anti-Ro and anti-La antibody levels strongly linked to fetal congenital heart block.

P<0.001
n=182

Why the study?

To evaluate the association between maternal anti-Ro and anti-La antibody levels and the occurrence of congenital heart block in fetuses and newborns.

Are higher maternal anti-Ro and anti-La antibody levels associated with an increased risk of congenital heart block in fetuses of seropositive pregnant women?

Key Points

To evaluate the association between maternal anti-Ro and anti-La antibody levels and the occurrence of congenital heart block in fetuses and newborns.
Retrospective cohort study of 182 pregnant women with positive anti-Ro and/or anti-La antibodies who received prenatal care at a tertiary center between 2002 and 2022.
Clinical, laboratory, and obstetric parameters were assessed, with congenital heart block defined as third-degree atrioventricular block and confirmed by neonatal echocardiography.
Congenital heart block occurred in 13 fetuses (7.1%), with affected mothers exhibiting significantly higher median anti-Ro (240 vs. 42; p < 0.001) and anti-La (150 vs. 10; p < 0.001) levels.
Mothers of fetuses with congenital heart block had higher rates of anti-La positivity (76.9% vs. 42.6%; p = 0.017), lower median complement C4 levels (14 vs. 19; p = 0.008), and shorter disease duration under 1 year (p = 0.008).
Pre-pregnancy hydroxychloroquine at 400 mg daily was less frequent among mothers of affected fetuses (30.8% vs. 60.5%; p = 0.044), as was preconception prednisone use (15.4% vs. 47.7%; p = 0.039).

Study Design

Type

Cohort (n=182)

Multicenter

No

Structured PICO

Are higher maternal anti-Ro and anti-La antibody levels associated with an increased risk of congenital heart block in fetuses of seropositive pregnant women?

P

Population

182 pregnant women with singleton pregnancies and positive anti-Ro and/or anti-La antibodies who received prenatal care at a tertiary center between 2002 and 2022.

I

Intervention

High maternal anti-Ro and anti-La antibody levels (quantified via ELISA)

C

Comparator

Low maternal anti-Ro and anti-La antibody levels

O

Outcome

Congenital heart block (third-degree atrioventricular block) in fetuses and newbornshard clinical

Main Result

Absolute Event Rate: 240% vs 42%

p-value: p=<0.001

Higher quantitative maternal anti-Ro and anti-La antibody levels are significantly associated with an increased risk of fetal congenital heart block, highlighting the importance of antibody burden in risk stratification.

Limitations

Retrospective design subject to information bias and missing data
Small sample size, particularly of fetuses affected by congenital heart block
Low frequency of congenital heart block restricts generalizability
Potential residual confounding from unmeasured clinical variables
Retrospective design inherently limits control over data collection and is subject to information bias, missing data, and potential misclassification
Relatively small sample size, particularly with respect to the number of fetuses affected by congenital heart block
Low frequency of congenital heart block restricts the generalizability of the findings
Residual confounding cannot be excluded as unmeasured or incompletely captured clinical variables may have influenced outcomes

Implication

May refine CHB risk stratification by titer in seropositive pregnancies; hypothesis-generating for threshold-guided trials.

Abstract

Objective To evaluate the association between maternal anti-Ro and anti-La antibody levels and the occurrence of congenital heart block (CHB) in fetuses and newborns. Methods This retrospective cohort study included 182 pregnant women with positive anti-Ro and/or anti-La antibodies who received prenatal care at our tertiary center between 2002 and 2022. Maternal clinical, laboratory, and obstetric variables were analyzed. Results Thirteen fetuses (7.1%) were diagnosed with CHB. Mothers of affected fetuses had significantly higher anti-Ro (median 240 vs. 42; p < 0.001) and anti-La (median 150 vs. 10; p < 0.001) levels. Anti-La positivity was more frequent in the CHB group (76.9% vs. 42.6%; p = 0.017). Lower complement C4 levels ( p = 0.008) and disease duration of less than 1 year since diagnosis ( p = 0.008) were also associated with CHB. Preconception hydroxychloroquine and prednisone use were less frequent in affected pregnancies ( p = 0.044 and p = 0.039, respectively). Conclusion Higher maternal anti-Ro and anti-La antibody levels were significantly associated with fetal CHB. Preconception hydroxychloroquine may provide a protective effect. Early diagnosis and specialized care are essential for optimizing neonatal outcomes.

Discussion

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Published by Archives of Gynecology and Obstetrics · CC BY

Cite This Study

Pannain et al. (2026) conducted a cohort in Pregnancy with positive anti-Ro and/or anti-La antibodies (n=182). Maternal anti-Ro and anti-La antibodies vs. Lower maternal antibody levels was evaluated on Median maternal anti-Ro antibody levels in pregnancies with fetal congenital heart block (p=<0.001). Higher maternal anti-Ro and anti-La antibody levels were significantly associated with fetal congenital heart block, with median anti-Ro levels of 240 in affected versus 42 in unaffected pregnancies.

synapsesocial.com/papers/699a9dcd482488d673cd3f54 https://doi.org/10.1007/s00404-026-08360-z

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Association between maternal anti-Ro and anti-La antibody levels and congenital heart block: a 20-year cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Association between maternal anti-Ro and anti-La antibody levels and congenital heart block: a 20-year cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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