Pregnancy complicated with autoimmune diseases causing fetal arrhythmia:prevention and management

ZHANG Yang; ZOU Li

doi:10.19538/j.fk2025060110

Abstract：Autoimmune diseases during pregnancy(such as systemic lupus erythematosus and antiphospholipid syndrome)are significant causes of fetal arrhythmia.Maternal anti-SSA/Ro and anti-SSB/La antibodies cross the placenta and attack the fetal cardiac conduction system,mediating myocardial injury and congenital heart block(CHB).Meanwhile,inflammatory factors and placental dysfunction further exacerbate fetal cardiac electrophysiological dysregulation.The clinical manifestations are primarily characterized by atrioventricular block(AVB),which may lead to heart failure or even intrauterine fetal demise in severe cases.Antenatal management requires a multidisciplinary approach,utilizing echocardiography to dynamically monitor fetal cardiac structure and electrophysiological activity and make early identification of incomplete AVB and myocardial injury markers.Hydroxychloroquine administration before and during pregnancy can reduce CHB risk,while glucocorticoid therapy may have potential interventional value for certain early lesions,though maternal-fetal safety must be rigorously evaluated.The evidence for intervention measures such as intravenous immunoglobulin and sympathomimetic agents remains limited,necessitating individualized risk-benefit assessment.This review systematically summarizes the pathological mechanisms,monitoring strategies,and intervention principles for fetal arrhythmia in pregnancy with autoimmune diseases,emphasizing the importance of integrated management across preconception,antepartum,and postpartum periods.Future research should focus on developing immune regulatory targets and precision diagnostic-therapeutic techniques to improve maternal-fetal outcomes.