Screening
Although the chance of having kids with CHB in anti Ro/La positive mothers is relatively low (1-5%), it is recommended that all mothers with autoimmune disease to be screened and seek consultation when decide to get pregnant.For mothers with at least one CHB-affected pregnancy, with 16 - 18% recurrence chance for the directly following pregnancy and an overall 9% chance in following ones, monitoring both the mother and the fetus is crucial. Treatment
Due to the rarity of this disease, there is a lack of comprehensive and high quality research about the different treatment options, and therefore, no specific treatment plan is followed globally. However, some studies have attempted to outline the most widely accepted approaches in dealing with CHB. Fluorinated steroids
There is no agreement on using fluorinated steroids in treating CHB, and the results of the different studies are contradictory. These steroids (such as dexamethasone) are used when the disease is diagnosed in utero as they can cross the placenta without being deactivated. The main goal of using corticosteroids is to mitigate the inflammation by decreasing the amount of anti Ro/La autoantibodies in the fetal serum. Therefore, they are used in the autoimmune-mediated CHB. Both the mother and the fetus might suffer from their side effects which can include growth problems and adrenal insufficiency. Beta-adrenergic agonist
Trebutaline and Sulbutamol are among the medications that have been used to treat CHB. They are used mainly to increase the heart rate in fetuses suffering from bradycardia. Although they showed positive results, some patients showed intolerance to their side effects.
Anti-La\SSB autoantibody
This antibody attacks the ribonucleoprotein La48 on the surface of the fetal cardiomyocytes, the links between this autoantibody and autoimmune CHB are less strong than the anti-Ro autoantibody and it usually accompanies it in the majority of cases.Although the autoimmune CHB has a relatively high mortality and morbidity rates, the chance of kids from -mothers positive to anti-Ro\SSA and/or anti-La\SSB antibodies- to suffer from CHB is only around 1-5%, which suggests the existence of other factors to influence the disease such as genetic and environmental factors. Other autoantibodies
Several autoantibodies were suggested to have links with the autoimmune CHB, mainly the ones associated with the different autoimmune diseases that are common among women (such as the antibodies associated with Systemic lupus erythematosus (SLE), Rheumatoid arthritis, Progressive systemic sclerosis (PSS), and Mixed connective tissue disease). However, the role of these autoantibodies was not studied comprehensively.Also, some antigens of the fetal heart tissue (apart from the "Ro" and the "La") were studied, but no clear link with the autoimmune CHB was proven. Congenital cardiac structural abnormalities
The presence of a cardiac structural abnormality is a major determination of the outcome of CHB. Its existence affects the conduction system of the heart and increases the mortality rate and the need for pace-maker implantation.The cardiac structural diseases that are usually associated with the congenital heart block include the left atrial isomerism with or without atrioventricular septal defect.