Anti-SSA/Ro positivity and congenital heart block: obstetric and foetal outcome in a cohort of anti-SSA/Ro positive pregnant patients with and without autoimmune diseases

OBJECTIVES

Neonatal lupus (NL) is an acquired disease caused by the transplacental passage of anti-SSA/Ro antibodies. The rate of congenital heart block (CHB), its most serious manifestation, ranges from 1 to 5%. The aim of this study was to retrospectively assess the prevalence of CHB in anti-SSA/Ro positive pregnant women with or without systemic autoimmune diseases from 2010 to 2020.

METHODS

Patients underwent monthly visit and a shared follow-up programme of weekly (16th-24th week) foetal heart rate assessment by obstetric ultrasound.

RESULTS

322 pregnancies in 258 anti-SSA/Ro patients were included; 314 were followed from the beginning of pregnancy because of the known presence of anti-SSA/Ro autoantibodies and 1 case of CHB occurred in an anti-SSA/Ro+ asymptomatic subject (0.3%). In the same period, 8 additional patients were referred to our clinics after in utero CHB diagnosis and subsequent discovery of anti-SSA/Ro without a disease diagnosis. Globally, 9 cases of congenital CHB (2.8%) occurred: 7 complete, 1 II-III degree and 1 rst degree CHB. Anti-SSB/La positivity was associated with a higher risk of CHB (7.8% vs. 1.2%; p=0.0071). No differences in maternal or foetal outcomes were found in comparison with a large cohort of unselected pregnancies except for caesarian section. Hydroxychloroquine (HCQ) was used in 58.3% pregnancies, with a different prevalence according with maternal diagnosis.

CONCLUSIONS

Our data suggest that anti-SSA/Ro positive patents with a de ned systemic autoimmune disease undergoing a strict follow-up since positive pregnancy test display a low risk of pregnancy complications, including but not limited to NL.

SAT0207 ANTI-SSA/RO POSITIVITY AND CONGENITAL HEART BLOCK: OBSTETRIC AND FETAL OUTCOME IN A COHORT OF ANTI-SSA/RO POSITIVE PREGNANT WOMEN WITH AND WITHOUT AUTO-IMMUNE DISEASES FROM THREE ITALIAN TERTIARY REFERRAL CENTERS

Background:

neonatal lupus syndrome (NLS) is an acquired disease caused by the trasplacental passage of anti-SSA antibodies. Congenital heart block (CHB) represents the most serious manifestation of NLS. The rate of CHB in Anti-SSA positive pregnant women ranges from 1 to 5% in different studies

Objectives:

to retrospectively assess the prevalence of CHB in a cohort of anti-SSA positive pregnant women followed in 3 Italian tertiary centers

Methods:

pregnancies of anti-SSA positive women attending the pregnancy clinic of ASST Pini CTO/Policlinico Mangiagalli, Rheumatology Division of Spedali Civili, Brescia and Rheumatology Division of Ospedale S Matteo, Pavia from 2009 to 2019 were included. Patients underwent monthly clinical examination. Fetal heart rate was assessed weekly by Doppler ultrasound from 14thto 26thgestational week. On week 14 and 26, a fetal echocardiography was performed. A EKG was performed at birth

Results:

351 prospectively followed pregnancies in 292 anti-SSA/Ro positive women were included. Table 1 reports diagnosis. None of the prospectively followed pregnancies were complicated by complete CHB. Seven additional patients were referred to our clinics after diagnosis of CHB and were subsequently found to be anti-SSA positive, reporting no symptoms of diseases. Considering the 7 additional pregnancies, the incidence of CHB was 1.9%. We observed 3 neonates (0.8%) with cutaneous NLS and 1 case of transient increase of liver enzymes. In another neonate, a 1thdegree A-V block was found after birth. A complete analysis of maternal and fetal outcome was possible in 244 cases (Table 2) and compared with 3158 unselected healthy controls. Among these 244 cases, 65% were taking hydroxychloroquine

Table 1.

patients diagnosis

n%Sjogren’s Syndrome58`20Systemic lupus erythematosus7626UCTD7425Asymptomatic Ro carriers5619Other2810292100Table 2.

maternal and fetal outcome

healthy controls N=3158Anti-SSA/Ro ptsN=244P valuePrevious CHB n (%)2 (0.8)Anti-SSB pos n (%)46 (18.8)aPL pos n (%)49 (20)PregnancyLive births3158241Preeclampsia, n (%)43 (1.1)2 (0.8)nsDeliveryDelivery <37 wks, n (%) / < 34 wks n (%)401 (12.6) /201 (6)35 (15.6) / 14 (6)ns / nsCesarean Section, n (%)897 (29.3)115 (47.5)<0.001

Conclusion:

none of the patients prospectively followed in our centers before and during pregnancy developed complete CHB. If the 7 cases of anti-SSA positivity diagnosed after CHB detection were included in the analysis, the incidence of CHB was comparable to previous reports. Our data suggest that a strict follow up and proper treatment of anti-SSA positive patients with or without an autoimmune disease before and during pregnancy can reduce the risk of NLS. Further studies are warranted to confirm a possible protective role of anti-rheumatic treatments, including HCQ

References:

[1]Fredi M. Front Cardiovasc Med. 2019

Disclosure of Interests:

Maria Gerosa: None declared, Micaela Fredi: None declared, Laura Andreoli: None declared, Cecilia Chighizola: None declared, Lorenza Maria Argolini: None declared, Davide Donzelli: None declared, Tamara Vojinovic: None declared, Véronique Ramoni: None declared, Elisa Bellis: None declared, Laura Trespidi: None declared, Federica Gazzola: None declared, Enrico Ferrazzi: None declared, Sonia Zatti: None declared, Fausta Benvenuti: None declared, Pier Luigi Meroni: None declared, Franco Franceschini: None declared, Carlomaurizio Montecucco: None declared, Rolando Cimaz: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB, Angela Tincani: None declared

Nature based solutions to mitigate soil sealing in urban areas: Results from a 4-year study comparing permeable, porous, and impermeable pavements

Soil sealing is one of the most pervasive forms of soil degradation that follows urbanization and, despite innovative pavements (i.e. pervious) are being installed in urban areas to mitigate it, there is little research on the effects of pervious pavements on soil water and carbon cycle and on the physiology of urban trees. The aim of this 4-year experiment was to assess the effects of three pavements, differing in permeability to water and gases, on some soil physical parameters, and on growth and physiology of newly planted Celtis australis and Fraxinus ornus. Treatments were: 1) impermeable pavement (asphalt on concrete sub-base); 2) permeable pavement (pavers on crushed rock sub-base); 3) porous design (porous pavement on crushed rock sub-base); 4) control (unpaved soil, kept free of weed by chemical control). Soil (temperature, moisture, oxygen content and CO₂ efflux) and plant (above- and below-ground growth, leaf gas exchange, chlorophyll fluorescence, water relations) parameters were measured. All types of pavements altered the water cycle compared to unpaved soil plots, but this disturbance was less intense in porous pavements than in other soil cover types. Porous pavements allowed both higher infiltration and evaporation of water than both pavers and asphalt. Reduction of evaporative cooling from soil paved with permeable and impermeable pavements contributed to significant soil warming: at 20cm depth, soils under concrete pavers and asphalt were 4 and 5°C warmer than soil covered by porous pavements and unpaved soils, respectively. Thus, enhancing evaporation from paved soil by the use of porous pavements may contribute to mitigating urban heat islands. CO₂ greatly accumulated under impermeable and permeable pavements, but not under porous pavements, which showed CO₂ efflux rates similar to control. Soil oxygen slightly decreased only beneath asphalt. Growth of newly planted C. australis and F. ornus was little affected by pavement type. Tree transpiration rapidly depleted soil moisture compared to the not-planted scenario, but soil moisture did not fall below wilting point (particularly in the deeper soil layers, i.e. 40-50cm) in any treatment. While C. australis showed similar leaf gas exchange and water relations in all treatments, F. ornus showed a depression in CO₂ assimilation and slight signs of stress of the photosynthetic apparatus when planted in soil covered with impermeable pavement. The effects of soil cover with different materials on tree growth and physiology were little, because newly planted trees have most of their roots still confined in the unpaved planting pit. Still, the reduction of soil sealing around the planting pit triggered the establishment of sensitive species such as ash. Further research is needed to assess the effects of different pavement types on established, larger trees.

Competition between trees and grasses for both soil water and mineral nitrogen in dry savannas

The co-existence of trees and grasses in savannas in general can be the result of processes involving competition for resources (e.g. water and nutrients) or differential response to disturbances such as fire, animals and human activities; or a combination of both broad mechanisms. In moist savannas, the tree-grass coexistence is mainly attributed to of disturbances, while in dry savannas, limiting resources are considered the principal mechanism of co-existence. Virtually all theoretical explorations of tree-grass dynamics in dry savannas consider only competition for soil water. Here we investigate whether coexistence could result from a balanced competition for two resources, namely soil water and mineral nitrogen. We introduce a simple dynamical resource-competition model for trees and grasses. We consider two alternative hypotheses: (1) trees are the superior competitors for nitrogen while grasses are superior competitors for water, and (2) vice-versa. We study the model properties under the two hypotheses and test each hypothesis against data from 132 dry savannas in Africa using Kendall's test of independence. We find that Hypothesis 1 gets much more support than Hypothesis 2, and more support than the null hypothesis that neither is operative. We further consider gradients of rainfall and nitrogen availability and find that the Hypothesis 1 model reproduces the observed patterns in nature. We do not consider our results to definitively show that tree-grass coexistence in dry savannas is due to balanced competition for water and nitrogen, but show that this mechanism is a possibility, which cannot be a priori excluded and should thus be considered along with the more traditional explanations.

Tree-grass co-existence in savanna: Interactions of rain and fire

The mechanisms permitting the co-existence of tree and grass in savannas have been a source of contention for many years. The two main classes of explanations involve either competition for resources, or differential sensitivity to disturbances. Published models focus principally on one or the other of these mechanisms. Here we introduce a simple ecohydrologic model of savanna vegetation involving both competition for water, and differential sensitivity of trees and grasses to fire disturbances. We show how the co-existence of trees and grasses in savannas can be simultaneously controlled by rainfall and fire, and how the relative importance of the two factors distinguishes between dry and moist savannas. The stability map allows to predict the changes in vegetation structure along gradients of rainfall and fire disturbances realistically, and to clarify the distinction between climate- and disturbance-dependent ecosystems.