Fetal Echocardiogram Timing in SSA-Positive Pregnancies

Screening Protocol

The American College of Rheumatology recommends beginning serial fetal echocardiography at 16-18 weeks and continuing through week 26 in pregnant women with anti-Ro/SSA and/or anti-La/SSB antibodies who have no history of a prior infant with congenital heart block (CHB) or neonatal lupus erythematosus (NLE) 1, 2, 3.
The frequency of fetal echocardiography should be less than weekly, with some centers performing monitoring every 1-2 weeks, in pregnant women with anti-Ro/SSA and/or anti-La/SSB antibodies who have no history of a prior infant with CHB or NLE 1.
CHB occurs in only approximately 2% of first pregnancies in anti-SSA-positive women, according to the American College of Rheumatology 1, 2, 3.

Weekly fetal echocardiography starting at 16-18 weeks through week 26 is recommended for women with a prior infant who had CHB or other NLE manifestations, as suggested by the American College of Rheumatology 1, 2, 3.
The recurrence risk is substantially higher at 13-18% in women with previously affected offspring, according to the American College of Rheumatology 1.

The American College of Rheumatology recommends that all anti-Ro/SSA and/or anti-La/SSB-positive pregnant women should be treated with hydroxychloroquine during pregnancy, based on retrospective data showing lower risk of CHB recurrence 1, 2, 3.
Low-titer antibodies are probably not associated with the same risk of CHB as higher titers, though specific thresholds are not well-established, as noted by the American College of Rheumatology 1, 2, 3.

The cost-effectiveness of intensive surveillance remains uncertain given the low absolute risk of CHB in women without prior affected children, according to the European League Against Rheumatism 4, 5.
At least 500 ultrasounds are needed to find one case of CHB, highlighting the need for careful consideration of screening protocols, as reported by the European League Against Rheumatism 4, 5.