The presence of maternal
autoantibodies to SS-A/Ro and/or SS-B/La is associated with the development of fetal heart block. There are data suggesting that maternal treatment with
steroids might reverse
heart block. We report on a pregnancy in a mother with secondary Sjögren syndrome and
systemic lupus erythematosus with presence of
autoantibodies to SS-A/Ro and SS-B/La, which was complicated by the development of incomplete fetal heart block. Oral
dexamethasone treatment could not prevent progression to complete
heart block and was associated with a number of complications.A review of the literature revealed 19 studies (including ours) in which 93 cases of fetal heart block were treated with maternal
steroid therapy. Complete
heart block proved irreversible in all cases; and of 13 fetuses with incomplete
heart block which received maternal
steroid therapy, three had a reduction in their degree of block and one reverted to sinus rhythm. Maternal
steroid therapy, initiated early in pregnancy and potentially preventing the onset of
heart block, did not decrease the incidence of
heart block in nine studies with 43 cases. Furthermore, the literature review revealed numerous serious side effects of maternal
steroid administration during pregnancy. Data on these potential side effects are lacking in the 28 studies discussed in this review. Maternal
dexamethasone therapy to prevent or treat fetal heart block remains, in our opinion, a questionable intervention and can as yet not be recommended in the clinical situation.