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Medicine Matters rheumatology

a. These antibodies begin crossing the placenta after 16 weeks of gestation and may originate neonatal lupus, for which the most feared complication is congenital heart block (CHB). Prevalence of this complication is low (0.7–2.0%) in women with no previous CHB, but there is a higher risk (16%) for recurrence in women with a previous affected child. Hydroxychloroquine seems to reduce the odds of CHB occurrence. According to local protocols, women with positive anti-Ro/SSA antibodies can be offered a surveillance protocol comprising fetal echocardiograms weekly/biweekly from 16 to 26 weeks of gestation.

b. These antibodies cross the placenta after 28 weeks of gestation and may originate neonatal lupus, for which the most feared complication is congenital heart block (CHB). Prevalence of this complication is high (30%) in women with no previous CHB, with an even higher risk (66%) in women with a previous affected child. Hydroxychloroquine seems to reduce the odds of CHB occurrence and ideally these women should be enrolled in a surveillance protocol comprising fetal echocardiograms weekly/biweekly from 28 weeks onwards and should also start treatment with fluorinated steroids in the third trimester.

c. These antibodies do not represent a major threat to fetus health than anti-dsDNA, and should be addressed accordingly.

d. These antibodies may cross the placenta after the first trimester of gestation, but are not able to cause neonatal lupus if the mother takes hydroxychloroquine on a daily basis.

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