Maternal steroid therapy for fetuses with second-degree immune-mediated congenital atrioventricular block: a systematic review and meta-analysis.

Andrea Ciardulli, Francesco D'Antonio, Elena R Magro-Malosso, Lamberto Manzoli, Paul Anisman, Gabriele Saccone, Vincenzo Berghella

Journal: Acta obstetricia et gynecologica Scandinavica 2019;97(7):787-794

PMID: 29512819

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Abstract

INTRODUCTION

The aim of this study was to explore the effect of maternal fluorinated steroid therapy on fetuses affected by second-degree immune-mediated congenital atrioventricular block.

MATERIAL AND METHODS

Studies reporting the outcome of fetuses with second-degree immune-mediated congenital atrioventricular block diagnosed on prenatal ultrasound and treated with fluorinated steroids compared with those not treated were included. The primary outcome was the overall progression of congenital atrioventricular block to either continuous or intermittent third-degree congenital atrioventricular block at birth. Meta-analyses of proportions using random effect model and meta-analyses using individual data random-effect logistic regression were used.

RESULTS

Five studies (71 fetuses) were included. The progression rate to congenital atrioventricular block at birth in fetuses treated with steroids was 52% (95% confidence interval 23-79) and in fetuses not receiving steroid therapy 73% (95% confidence interval 39-94). The overall rate of regression to either first-degree, intermittent first-/second-degree or sinus rhythm in fetuses treated with steroids was 25% (95% confidence interval 12-41) compared with 23% (95% confidence interval 8-44) in those not treated. Stable (constant) second-degree congenital atrioventricular block at birth was present in 11% (95% confidence interval 2-27) of cases in the treated group and in none of the newborns in the untreated group, whereas complete regression to sinus rhythm occurred in 21% (95% confidence interval 6-42) of fetuses receiving steroids vs. 9% (95% confidence interval 0-41) of those untreated.

CONCLUSIONS

There is still limited evidence as to the benefit of administered fluorinated steroids in terms of affecting outcome of fetuses with second-degree immune-mediated congenital atrioventricular block.

Address: Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy.; Faculty of Health Sciences, Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway.; Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway.; Division of Pediatrics, Obstetrics and Gynecology, Department of Health Science, Careggi Hospital University of Florence, Florence, Italy.; Department of Medicine Sciences, University of Ferrara, Ferrara, Italy.; Nemours Cardiac Center, A.I. duPont Institute, Wilmington, DE, USA.; Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.

DOI: 10.1111/aogs.13338