Variation in prenatal surveillance and management of anti-SSA/Ro autoantibody positive pregnancies

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Anti-SSA/Ro autoantibody positive pregnancies (fetal cardiac neonatal lupus and atrioventricular block surveillance/management) (n=101). Intervention: Prenatal cardiac surveillance and management practices for anti-SSA/Ro autoantibody positive pregnancies. Primary outcome: Institution-based risk stratification by anti-SSA/Ro autoantibody titer and fetal cardiac surveillance methods.

Q: What does this research mean for the field?

Clinical surveillance, risk stratification, and treatment strategies for anti-SSA/Ro autoantibody-positive pregnancies vary widely across institutions, with most clinicians relying on clinical experience rather than titer-based risk stratification. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Lisa Howley; Stephanie A. Eyerly‐Webb; Stacy A. S. Killen; E. Paul; Anita Krishnan; Melanie R. F. Gropler; Bailey Drewes; Éric Dion; Amy E. Lund; Jill P. Buyon; Bettina F. Cuneo

doi:10.1080/14767058.2024.2323623

January 2, 2024The Journal of Maternal-Fetal & Neonatal MedicineOpen Access

Variation in prenatal surveillance and management of anti-SSA/Ro autoantibody positive pregnancies

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Key result

Anti-SSA/Ro pregnancy management varies widely, with ~79% of clinicians not risk-stratifying by titer.

n=101

Why the study?

International surveillance and treatment strategies for managing anti-SSA/Ro autoantibody positive pregnancies needed to be described.

Key Points

To describe international surveillance and treatment strategies for managing anti-SSA/Ro autoantibody positive pregnancies.
Distributed an electronic REDCap questionnaire to Fetal Heart Society and North American Fetal Therapy Network members querying risk stratification, surveillance methods and frequency, conduction abnormality therapies, and postnatal assessment.
Collected and analyzed 101 survey responses across 59 centers (59% US, 17% international), completed by pediatric cardiologists (73.3%) and maternal-fetal medicine physicians (26.7%).
Most respondents (79.2%) did not risk-stratify pregnancies by anti-SSA/Ro titer, while 33.7% performed routine fetal cardiac surveillance for patients with rheumatologic diagnoses regardless of anti-SSA/Ro status.
Fetal echocardiography was the primary surveillance method (94.1%), conducted weekly (31.6%), every other week (51.6%), or monthly (11.6%), typically initiated between 16–18 weeks and discontinued after 28 weeks.
Most respondents reported treating 2° and 3° fetal atrioventricular block, most commonly using dexamethasone and/or IVIG, and 77.2% ordered routine postnatal electrocardiograms for uneventful pregnancies.

Study Design

Type

Cross-Sectional (n=101)

Multicenter

Yes

Structured PICO

P

Population

101 pediatric cardiologists (73.3%) and maternal-fetal medicine physicians (26.7%) across 59 US and international centers managing anti-SSA/Ro autoantibody positive pregnancies.

E

Exposure

Electronic REDCap survey assessing prenatal surveillance and management strategies for anti-SSA/Ro autoantibody positive pregnancies (including fetal echocardiography, home and in-office fetal heart rate monitoring, and medical treatment with dexamethasone and/or IVIG)

O

Outcome

Institution-based patient risk stratification methods, frequency and modes of fetal cardiac surveillance, treatment of conduction system and extranodal abnormalities, and postnatal management of offspring of anti-SSA/Ro autoantibody positive pregnancies

This international survey reveals substantial practice variation in risk stratification, fetal cardiac surveillance, and treatment of anti-SSA/Ro autoantibody positive pregnancies, underscoring the urgent need for standardized, evidence-based clinical guidelines.

Limitations

Limited number of survey responses received
Vast majority of respondents were from medical practices in the United States and developed economies, with few from Asia, South America, or Africa
Majority of responses were from academic medical groups (79.2%), limiting conclusions about private practice management
Limited number of responses received, with the vast majority from medical practices in the US.
Results primarily reflect physicians in developed economies with very few respondents from developing economies (Asia, South America, or Africa).
Majority of responses were from academic medical groups (79.2%), making it difficult to draw conclusions on management differences in private practice.

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Implication

Inconsistent anti-SSA/Ro pregnancy surveillance warrants clinician caution; leaves open optimal risk stratification and echocardiography protocols.

Abstract

OBJECTIVE: To describe international surveillance and treatment strategies for managing anti-SSA/Ro autoantibody positive pregnancies. STUDY DESIGN: An electronic REDCap questionnaire was distributed to Fetal Heart Society and North American Fetal Therapy Network members which queried institution-based risk stratification, surveillance methods/frequency, conduction abnormality treatments, and postnatal anti-SSA/Ro pregnancy assessment. RESULTS: 101 responses from 59 centers (59% US, 17% international) were collected. Most (79%) do not risk stratify pregnancies by anti-SSA/Ro titer; those that do use varied cutoff values. Many pregnant rheumatology patients are monitored for cardiac abnormalities regardless of maternal anti-SSA/Ro status. Surveillance strategies were based on maternal factors (anti-SSA/Ro status 85%, titer 25%, prior affected child 79%) and monitoring durations varied. Most respondents treat 2° and 3° fetal atrioventricular block, commonly with dexamethasone and/or IVIG. CONCLUSIONS: Wide variation exists in current fetal cardiac surveillance and treatment for anti-SSA/Ro autoantibody positive pregnancies, highlighting the need for evidence-based protocols to optimize care.

Discussion

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Cite This Study

Howley et al. (2024) conducted a cross-sectional in Anti-SSA/Ro autoantibody positive pregnancies (fetal cardiac neonatal lupus and atrioventricular block surveillance/management) (n=101). Prenatal cardiac surveillance and management practices for anti-SSA/Ro autoantibody positive pregnancies was evaluated on Institution-based risk stratification by anti-SSA/Ro autoantibody titer and fetal cardiac surveillance methods. Prenatal management of anti-SSA/Ro positive pregnancies varied widely across 101 respondents, with 79.2% not risk-stratifying by antibody titer and 94.1% using fetal echocardiography for surveillance.

synapsesocial.com/papers/6a857999a95ccb34714e28a8 https://doi.org/10.1080/14767058.2024.2323623

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Variation in prenatal surveillance and management of anti-SSA/Ro autoantibody positive pregnancies

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Variation in prenatal surveillance and management of anti-SSA/Ro autoantibody positive pregnancies

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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