Maternal steroid therapy for fetuses with second‐degree immune‐mediated congenital atrioventricular block: a systematic review and meta‐analysis

Ciardulli, Andrea; D’Antonio, F.; Magro-Malosso, Elena Rita; Manzoli, Lamberto; Anisman, P.; Saccone, Gabriele; Berghella, Vincenzo

doi:10.1111/aogs.13338

Cited by 51 publications

(33 citation statements)

References 19 publications

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“…Fluorinated glucocorticoids (dexamethasone and betamethasone) are recommended in these particular situations because they are not inactivated by placental 11-beta dehydrogenase, a property which allows them to reach the fetal circulation. Nonetheless, there is limited evidence regarding their efficacy in reducing mortality in patients with cardiac neonatal lupus, while the risks of the therapy have been clearly determined not only in infants (oligohydramnios, growth restriction), but also in mothers (infections, hypertension, avascular necrosis, insulin resistance, gestational diabetes), especially with longer-term treatment [ 90 ].…”

Section: Management Of Positive Anti-ro/ssa Pregnanciesmentioning

confidence: 99%

A Broader Perspective on Anti-Ro Antibodies and Their Fetal Consequences—A Case Report and Literature Review

Popescu

Dudu²,

Jurcuţ³

et al. 2020

Diagnostics

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The presence of maternal Anti-Ro/Anti-La antibodies causes a passively acquired autoimmunity that may be associated with serious fetal complications. The classic example is the autoimmune-mediated congenital heart block (CHB) which is due in most cases to the transplacental passage of Anti-Ro/Anti-La antibodies. The exact mechanisms through which these pathologic events arise are linked to disturbances in calcium channels function, impairment of calcium homeostasis and ultimately apoptosis, inflammation and fibrosis. CHB still represents a challenging diagnosis and a source of debate regarding the best management. As the third-degree block is usually irreversible, the best strategy is risk awareness and prevention. Although CHB is a rare occurrence, it affects one in 20,000 live births, with a high overall mortality rate (up to 20%, with 70% of in utero deaths). There is also concern over the lifelong consequences, as most babies need a pacemaker. This review aims to offer, apart from the data needed for a better understanding of the issue at hand, a broader perspective of the specialists directly involved in managing this pathology: the rheumatologist, the maternal–fetal specialist and the cardiologist. To better illustrate the theoretical facts presented, we also include a representative clinical case.

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Section: Management Of Positive Anti-ro/ssa Pregnanciesmentioning

confidence: 99%

A Broader Perspective on Anti-Ro Antibodies and Their Fetal Consequences—A Case Report and Literature Review

Popescu

Dudu²,

Jurcuţ³

et al. 2020

Diagnostics

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“…Fluorinated steroids aim to reduce inflammation. The most used is dexamethasone (4 to 8mg daily, tapered to 2mg towards end of pregnancy) despite its unproven efficacy regarding AV block, cardiomyopathy or survival [53][54][55]. However, recent small series observations suggest beneficial effect if treatment (dexamethasone and/or IVIG) is started within 24h [56].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Fetal dysrhythmias

Carvalho

2019

Best Practice & Research Clinical Obstetrics & Gynaecol

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Fetal dysrhythmias are common, usually manifesting as irregular rhythms. Whilst most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different aetiological and prognostic implications. We provide a flowchart for initial management of irregular rhythm, to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to haemodynamic compromise and may require in-utero therapy. Pharmacological treatment of tachycardia depends on type (supraventricular tachycardia or atrial flutter) and presence of hydrops, with digoxin, flecainide and sotalol being commonly used. An ongoing randomized trial may best inform about their efficacy. Bradycardia due to blocked bigeminy normally resolves spontaneously, but if due to established complete heart block there is no effective treatment. Ongoing research suggests hydroxychloroquine may reduce the risk of auto-immune atrioventricular block. Sinus bradycardia (rate < 3 rd centile) may be a prenatal marker for long QT syndrome.

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“…Alternatively, meta-analysis is a useful statistical approach method to analyze the divergence among several independent studies by interrogating available data published. In addition, meta-analysis of genetic association study provide a better power to derive a more precise relationship between gene polymorphisms and disease susceptibility [36][37][38] . Currently, most of meta-analyses of genetic association studies are usually conducted by comparing genotype frequencies between cases and controls under various genetic models.…”

Section: Meta-analysis Of Genetic Association Study In Diseasesmentioning

confidence: 99%

“…A study with meta-analysis of genetic association has been conducted to show the relationship between MMP gene polymorphisms and lung cancer by logistic regression analysis 36 . In addition, meta-analysis has also been used to investigate the relationship of steroid medication and outcome of congenital conduction disorder 38 . However, no meta-analysis of genetic association study has been reported for the relationship between acquired AVB and MMP gene polymorphisms.…”

Section: Meta-analysis Of Genetic Association Study In Diseasesmentioning

confidence: 99%

Matrix metalloproteinase 1 1 G/2 G gene polymorphism is associated with acquired atrioventricular block via linking a higher serum protein level

Chen

Chang

Liou

2020

Sci Rep

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in humans and animals demonstrated that modulation of MMP and RAS gene expression could lead to atrial fibrillation 19,20 , non-familial sick sinus syndrome 21 , and affect cardiac conduction after myocardial infarction 17 , apoptosis of the conductive system 22 and occurrence of ventricular arrhythmia 23. Here, we examined whether the polymorphisms of the genes encoding the MMPs and ACE could alter the disease susceptibility for acquired AVB by investigating the relationship between MMPs and ACE gene polymorphisms and disease susceptibility of acquired AVB. The results obtained indicated that MMP1 1 G/2 G gene polymorphism is associated with AVB via linking a higher serum protein level.

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Maternal steroid therapy for fetuses with second‐degree immune‐mediated congenital atrioventricular block: a systematic review and meta‐analysis

Abstract: There is still limited evidence as to the benefit of administered fluorinated steroids in terms of affecting outcome of fetuses with second-degree immune-mediated congenital atrioventricular block.

Cited by 51 publications

References 19 publications

A Broader Perspective on Anti-Ro Antibodies and Their Fetal Consequences—A Case Report and Literature Review

A Broader Perspective on Anti-Ro Antibodies and Their Fetal Consequences—A Case Report and Literature Review

Fetal dysrhythmias

Matrix metalloproteinase 1 1 G/2 G gene polymorphism is associated with acquired atrioventricular block via linking a higher serum protein level

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