TY - JOUR
T1 - The prevention, screening and treatment of congenital heart block from neonatal lupus
T2 - A survey of provider practices
AU - Clowse, Megan E.B.
AU - Eudy, Amanda M.
AU - Kiernan, Elizabeth
AU - Williams, Matthew R.
AU - Bermas, Bonnie
AU - Chakravarty, Eliza
AU - Sammaritano, Lisa R.
AU - Chambers, Christina D.
AU - Buyon, Jill
N1 - Funding Information:
Funding: This work was supported by National Institutes of Health [R13AR070007].
Funding Information:
Disclosure statement: B.B. receives support from UCB, Inc. and is an author of UpToDate Review Cards. C.D.C. receives/received research funding from the following industry sponsors: AbbVie, Amgen Inc., Apotex, Barr Laboratories, Inc., Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen Pharmaceuticals, Kali Laboratories, Inc., Pfizer, Inc., Hoffman La Roche-Genentech, Sandoz Pharmaceuticals, Sanofi, Genzyme Sanofi-Aventis, Seqirus, Takeda Pharmaceutical Company Limited, Teva Pharmaceutical Industries Ltd. and UCB, USA. J.B. has a National Institutes of Health grant to study Congenital Heart Block and is the author of the UpToDate topic on neonatal lupus. All other authors have declared no conflicts of interest.
Publisher Copyright:
© 2018 The Author(s). All rights reserved.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Objective: To survey an international sample of providers to determine their current practices for the prevention, screening, and treatment of congenital heart block (CHB) due to maternal Ro/SSA antibodies. Methods: A survey was designed by the organizing committee of the 9th International Conference of Reproduction, Pregnancy and Rheumatic Diseases. It was sent to attendants of the conference and authors of recent publications or abstracts at ACR 2012, 2013 or 2014 on rheumatic diseases and pregnancy. Results: In anti-Ro/SSA positive women, 80% of 49 respondents recommended screening by serial fetal echocardiogram (ECHO), with most starting at week 16 (59%) and stopping at week 28 (25%), although the time to stop varied widely. For women without a prior infant with neonatal lupus, respondents recommend every other week (44%) or weekly (28%) fetal ECHOs. For women with a prior infant with neonatal lupus, 80% recommend weekly fetal ECHOs. To prevent CHB, HCQ was recommended by 67% of respondents and most would start pre-pregnancy (62%). Respondents were asked about medications to treat varying degrees of CHB in a 20-week pregnant, anti-Ro and La positive SLE patient. For first degree, respondents recommended starting dexamethasone (53%) or HCQ (43%). For second degree, respondents recommended starting dexamethasone (88%). For third degree, respondents recommended starting dexamethasone (55%) or IVIg (33%), although 27% would not start treatment. Conclusion: Despite the absence of official guidelines, many physicians with a focus on pregnancy and rheumatic disease have developed similar patterns in the screening, prevention and treatment of CHB.
AB - Objective: To survey an international sample of providers to determine their current practices for the prevention, screening, and treatment of congenital heart block (CHB) due to maternal Ro/SSA antibodies. Methods: A survey was designed by the organizing committee of the 9th International Conference of Reproduction, Pregnancy and Rheumatic Diseases. It was sent to attendants of the conference and authors of recent publications or abstracts at ACR 2012, 2013 or 2014 on rheumatic diseases and pregnancy. Results: In anti-Ro/SSA positive women, 80% of 49 respondents recommended screening by serial fetal echocardiogram (ECHO), with most starting at week 16 (59%) and stopping at week 28 (25%), although the time to stop varied widely. For women without a prior infant with neonatal lupus, respondents recommend every other week (44%) or weekly (28%) fetal ECHOs. For women with a prior infant with neonatal lupus, 80% recommend weekly fetal ECHOs. To prevent CHB, HCQ was recommended by 67% of respondents and most would start pre-pregnancy (62%). Respondents were asked about medications to treat varying degrees of CHB in a 20-week pregnant, anti-Ro and La positive SLE patient. For first degree, respondents recommended starting dexamethasone (53%) or HCQ (43%). For second degree, respondents recommended starting dexamethasone (88%). For third degree, respondents recommended starting dexamethasone (55%) or IVIg (33%), although 27% would not start treatment. Conclusion: Despite the absence of official guidelines, many physicians with a focus on pregnancy and rheumatic disease have developed similar patterns in the screening, prevention and treatment of CHB.
KW - DMARDs
KW - attitude of health professionals
KW - autoinflammatory conditions
KW - cardiovascular
KW - education research
KW - laboratory diagnosis
KW - medical education
KW - pregnancy and rheumatic disease
KW - systematic lupus erythematosus and autoimmunity
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U2 - 10.1093/rheumatology/key141
DO - 10.1093/rheumatology/key141
M3 - Review article
C2 - 30137589
AN - SCOPUS:85052584124
SN - 1462-0324
VL - 57
SP - V9-V17
JO - Rheumatology and Rehabilitation
JF - Rheumatology and Rehabilitation
ER -