Fetal heart rate monitoring is feasible, accurate for managing high-risk pregnancies

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New research presented this week at ACR Convergence, the annual meeting of the American College of Rheumatology, shows that heart rate monitoring is a feasible and accurate tool for checking heart rhythm abnormalities in the fetuses of pregnant women with anti-Ro/SSA antibodies (Abstract #1464).

Women with anti-Ro/SSA antibodies are at increased risk of developing pregnancy complications, including congenital heart block. Ro/SSA antibodies may be present in rheumatic diseases such as systemic lupus erythematosus, also known as SLE or lupus, and Sjögren’s syndrome.

Congenital heart block occurs in approximately 2% of pregnancies in women with anti-Ro/SSA antibodies, and carries a serious risk of fetal disease or death. Nearly all survivors of congenital heart block require a pacemaker for life. There is data to suggest that anti-inflammatory treatment of congenital heart block in the early stages can prevent progression to complete obstruction, but clinicians are still searching for the optimal strategy for detecting exacerbating and potentially irreversible rapid conduction disease. This study evaluated fetal heart rate and rhythm technique, or FHRM, in high-risk mothers for feasibility, acceptability, and accuracy.

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Unfortunately, when the heart block is complete, it does not reverse. However, there may be a time frame during which the lump is not complete, and treatment will be effective. The aim of this study was to enable a woman to be able to detect an abnormality in her baby’s heart rate or rhythm that could be quickly treated in the hope of reversing it. “

Jill B-Boyon, MD, a rheumatologist at NYU Langone Health and senior author of the study

Current strategies for monitoring women with anti-Ro/SSA antibodies include weekly or bi-monthly monitoring by echocardiography. “By the time the problem is identified, it may be permanent. This study also aims to show that not all mothers with anti-SSA/Ro need extensive monitoring, but only those with very high levels of antibody.”

The mothers who agreed to be included in the current study were positive for Ro/SSA antibodies and were divided into two groups: high and low anti-Ro60 and anti-Ro52 titers. An elevated titer threshold was defined as anti-Ro60 or anti-Ro52 antibodies at 1000 IU or greater based on the evaluation of 50 other mothers in the NYU Neonatal Lupus Research Registry who had previously given birth to a child with congenital heart block.

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Mothers with anti-Ro60 or anti-Ro52 antibodies above the high risk threshold were trained to perform FHRM with an instructional video and personalized instructions from a pediatric cardiologist on how to use the monitor. From week 17 to 25 of pregnancy, they performed FHRM three times daily, in addition to performing weekly or biweekly fetal echocardiography. They submit their FHRM results to a data monitoring center. If the mother notices an abnormality, they are referred immediately for a fetal echocardiogram if necessary. After birth, all infants underwent ECGs and congenital heart block was evaluated.

Thirty-seven mothers performed a FRHM for the study, submitting a total of 3,360 audio texts for evaluation. 39 recordings were sent from five concerned mothers, prompting a cardiologist to be consulted immediately. All recordings were normal, and in both cases, an emergency echocardiogram was performed within six hours. Both cases included premature atrial contractions that confirmed an abnormal FHRM result, but no evidence of conduction disease. Follow-up echocardiography was normal. There were no cases of congenital heart block at birth for any of the children in the study.

“By providing mothers with the ability to monitor their fetuses, we hope that there will be greater confidence in the management of the pregnancy and that abnormalities can be recognized when treatment is effective,” says Dr. Boyon. “It is possible that home monitoring can reduce the number of echocardiograms, as well as reduce the burden on the mother in terms of frequent visits to pediatric cardiologists.”

This research was supported by funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.

Source:

American College of Rheumatology

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