Foetal echocardiographic surveillance in anti-SSA/Ro-SSB/La-positive SLE pregnancies: risk stratification of congenital heart block

OBJECTIVE: To evaluate the clinical utility of serial foetal echocardiographic surveillance, specifically atrioventricular interval (AVI) monitoring, in managing anti-SSA/Ro-SSB/La-Positive SLE pregnancies. METHODS: SLE pregnancies with positive anti-SSA/Ro-SSB/La antibodies were retrospectively included (n = 50). Pregnancies were stratified into two groups based on whether optimal pre-gestational conditions were met. All pregnancies underwent serial foetal echocardiography, including structural assessment and precise AVI measurement. RESULTS: The overall incidence of foetal cardiac conduction abnormalities was 12% (6/50). The incidence was significantly higher in the suboptimal-conditions group (Group 2, 26% [5/19]) compared with the optimal-conditions group (Group 1, 3% [1/31]) (P = 0.024). Through close monitoring, one foetus with persistent AVI prolongation received dexamethasone and intravenous immunoglobulin, successfully preventing progression to advanced heart block; the other five cases normalized spontaneously upon short-term follow-up, avoiding overtreatment. CONCLUSION: SLE pregnancies with anti-SSA/Ro-SSB/La antibodies and suboptimal gestational conditions constitute a distinct high-risk subgroup. A management strategy through risk-stratified serial foetal AVI monitoring allows for precise treatment identification, significantly improving neonatal outcomes while avoiding unnecessary interventions.