Abstract 4362430: Maternal Socioeconomic Status Impacts Diagnosis and Surveillance of Anti-Ro/SSA Positive Pregnancies Complicated by Fetal Cardiac Neonatal Lupus: A Fetal Heart Society (FHS) Research Collaborative Study

Introduction: Knowing maternal anti-Ro antibody status prior to pregnancy is important since surveillance can detect early and treatable manifestations of fetal cardiac neonatal lupus (CNL); unfortunately, antibodies are identified after fetal CNL diagnosis in about 50% of cases. Studies have shown that prenatal detection of congenital heart disease falls short in patients of lower socioeconomic status, but effects of social health determinants on timing of anti-Ro diagnosis are unknown. We sought to determine whether neighborhood deprivation was associated with late detection of anti-Ro antibodies. Methods: A retrospective, multicenter, FHS cohort identified fetuses/infants with CNL between January 2013-2024. We compared race, ethnicity, childhood opportunity index (COI, diversitydatakids.org) and proximity to subspecialty care between pregnant persons with prior knowledge of anti-Ro+ and those diagnosed after onset of fetal CNL (atrioventricular block [AVB], cardiomyopathy, valvulitis, hydrops and/or endocardial fibroelastosis). Statistical tests included linear regression, Mann-Whitney, and Fisher’s exact performed in Rv4.2.2. Results: In our cohort of 234 anti-Ro+ pregnancies from 22 centers, 236 fetuses/infants had CNL. Over half (58.6%) were unaware of anti-Ro status at CNL diagnosis. There were no racial or ethnic differences in maternal knowledge of anti-Ro status prior to CNL diagnosis. Neighborhood deprivation (low/very low COI Social/Economic Domain) and public insurance were associated with late detection of anti-Ro antibodies (p=0.024 and p=0.004, respectively). For those with lower COI, distance to maternal-fetal-medicine (MFM, p=0.017) was significantly increased. Gestational age (GA) at CNL diagnosis and proximity to MFM (p=0.002) or cardiology (p=0.027) were significantly associated; for every 10-mile increase in distance to MFM or cardiology, GA at diagnosis increased by 0.14 weeks (95% CI: 0.05-0.23 weeks) or by 0.06 weeks (95% CI: 0.01-0.12 weeks), respectively. Pregnancies with known anti-Ro+ status were diagnosed with CNL 1.5 weeks earlier (p=0.002; 95% CI: 0.6-2.5 weeks). Conclusions: Pregnant persons with public insurance or from lower opportunity neighborhoods were less likely to know their anti-Ro status prior to fetal/infantile CNL diagnosis and at a GA in which rapid treatment could be effective. Universal anti-Ro pregnancy screening could potentially mitigate these disparities.

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Journal
Circulation
Published
2025-11-03
DOI
https://doi.org/10.1161/circ.152.suppl_3.4362430
Primary Topic
Systemic Lupus Erythematosus Research
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article
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Abstract 4362430: Maternal Socioeconomic Status Impacts Diagnosis and Surveillance of Anti-Ro/SSA Positive Pregnancies Complicated by Fetal Cardiac Neonatal Lupus: A Fetal Heart Society (FHS) Research Collaborative Study

Stefani Samples, Anita Krishnan, Flora Nuñez Gallegos, Lisa Gilbert et al.
Circulation
Systemic Lupus Erythematosus Research
article

Abstract 4362430: Maternal Socioeconomic Status Impacts Diagnosis and Surveillance of Anti-Ro/SSA Positive Pregnancies Complicated by Fetal Cardiac Neonatal Lupus: A Fetal Heart Society (FHS) Research Collaborative Study

Stefani Samples, Anita Krishnan, Flora Nuñez Gallegos, Lisa Gilbert, Emily M. Bucholz, Katherine J. DeWeert, Joshua A. Copel, Colin K. L. Phoon, Mary T. Donofrio, Melanie R. F. Gropler, Tam Doan, Catherine Ikemba, Angira Patel, Ranjini Srinivasan, Whitnee Hogan, Alexander Kaizer, Stacy A. S. Killen, Bettina F. Cuneo, Chris Lindblade, Amanda McIntosh, Bhawna Arya, Anita J. Moon‐Grady, Jill P. Buyon, Nelangi M. Pinto, Lisa K. Hornberger, Carol McFarland, Michelle Kaplinski, Stéphanie Levasseur, Maria Kiaffas, Miwa Geiger, Katherine Kohari, E. Paul, Lisa Howley, Shardha Srinivasan, Kavita Sharma, Sonal T. Owens
article en

Abstract

Introduction: Knowing maternal anti-Ro antibody status prior to pregnancy is important since surveillance can detect early and treatable manifestations of fetal cardiac neonatal lupus (CNL); unfortunately, antibodies are identified after fetal CNL diagnosis in about 50% of cases. Studies have shown that prenatal detection of congenital heart disease falls short in patients of lower socioeconomic status, but effects of social health determinants on timing of anti-Ro diagnosis are unknown. We sought to determine whether neighborhood deprivation was associated with late detection of anti-Ro antibodies. Methods: A retrospective, multicenter, FHS cohort identified fetuses/infants with CNL between January 2013-2024. We compared race, ethnicity, childhood opportunity index (COI, diversitydatakids.org) and proximity to subspecialty care between pregnant persons with prior knowledge of anti-Ro+ and those diagnosed after onset of fetal CNL (atrioventricular block [AVB], cardiomyopathy, valvulitis, hydrops and/or endocardial fibroelastosis). Statistical tests included linear regression, Mann-Whitney, and Fisher’s exact performed in Rv4.2.2. Results: In our cohort of 234 anti-Ro+ pregnancies from 22 centers, 236 fetuses/infants had CNL. Over half (58.6%) were unaware of anti-Ro status at CNL diagnosis. There were no racial or ethnic differences in maternal knowledge of anti-Ro status prior to CNL diagnosis. Neighborhood deprivation (low/very low COI Social/Economic Domain) and public insurance were associated with late detection of anti-Ro antibodies (p=0.024 and p=0.004, respectively). For those with lower COI, distance to maternal-fetal-medicine (MFM, p=0.017) was significantly increased. Gestational age (GA) at CNL diagnosis and proximity to MFM (p=0.002) or cardiology (p=0.027) were significantly associated; for every 10-mile increase in distance to MFM or cardiology, GA at diagnosis increased by 0.14 weeks (95% CI: 0.05-0.23 weeks) or by 0.06 weeks (95% CI: 0.01-0.12 weeks), respectively. Pregnancies with known anti-Ro+ status were diagnosed with CNL 1.5 weeks earlier (p=0.002; 95% CI: 0.6-2.5 weeks). Conclusions: Pregnant persons with public insurance or from lower opportunity neighborhoods were less likely to know their anti-Ro status prior to fetal/infantile CNL diagnosis and at a GA in which rapid treatment could be effective. Universal anti-Ro pregnancy screening could potentially mitigate these disparities.

CirculationVol. 152(Suppl_3)
Lurie Children's Hospital (US), Children's Mercy Hospital (US), Children's National (US), University of Alberta (CA), City College of San Francisco (US), University of California, San Francisco (US), University of Utah (US), University of Michigan (US), UW Health University Hospital (US), Tucson Medical Center (US), Yale University (US), Southwestern Medical Center (US), Goryeb Children's Hospital (US), Mount Sinai Hospital (US), Seattle Children's Hospital (US), Michigan United (US), Phoenix Children's Hospital (US), Children's Minnesota (US), Comanche National Museum and Cultural Center (US), Stanford Medicine (US), Texas Children's Hospital (US), New York University (US), University of San Francisco (US), Columbia University (US), The University of Texas Southwestern Medical Center (US), Vanderbilt University Medical Center (US), University of Colorado Denver (US)
Openalex Percentile: Top 54%
Systemic Lupus Erythematosus Research
DOISourceOpenAlex
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