Abstract 4362430: Maternal Socioeconomic Status Impacts Diagnosis and Surveillance of Anti-Ro/SSA Positive Pregnancies Complicated by Fetal Cardiac Neonatal Lupus: A Fetal Heart Society (FHS) Research Collaborative Study

Abstract

Introduction: Knowing maternal anti-Ro antibody status prior to pregnancy is important since surveillance can detect early and treatable manifestations of fetal cardiac neonatal lupus (CNL); unfortunately, antibodies are identified after fetal CNL diagnosis in about 50% of cases. Studies have shown that prenatal detection of congenital heart disease falls short in patients of lower socioeconomic status, but effects of social health determinants on timing of anti-Ro diagnosis are unknown. We sought to determine whether neighborhood deprivation was associated with late detection of anti-Ro antibodies. Methods: A retrospective, multicenter, FHS cohort identified fetuses/infants with CNL between January 2013-2024. We compared race, ethnicity, childhood opportunity index (COI, diversitydatakids.org) and proximity to subspecialty care between pregnant persons with prior knowledge of anti-Ro+ and those diagnosed after onset of fetal CNL (atrioventricular block [AVB], cardiomyopathy, valvulitis, hydrops and/or endocardial fibroelastosis). Statistical tests included linear regression, Mann-Whitney, and Fisher’s exact performed in Rv4.2.2. Results: In our cohort of 234 anti-Ro+ pregnancies from 22 centers, 236 fetuses/infants had CNL. Over half (58.6%) were unaware of anti-Ro status at CNL diagnosis. There were no racial or ethnic differences in maternal knowledge of anti-Ro status prior to CNL diagnosis. Neighborhood deprivation (low/very low COI Social/Economic Domain) and public insurance were associated with late detection of anti-Ro antibodies (p=0.024 and p=0.004, respectively). For those with lower COI, distance to maternal-fetal-medicine (MFM, p=0.017) was significantly increased. Gestational age (GA) at CNL diagnosis and proximity to MFM (p=0.002) or cardiology (p=0.027) were significantly associated; for every 10-mile increase in distance to MFM or cardiology, GA at diagnosis increased by 0.14 weeks (95% CI: 0.05-0.23 weeks) or by 0.06 weeks (95% CI: 0.01-0.12 weeks), respectively. Pregnancies with known anti-Ro+ status were diagnosed with CNL 1.5 weeks earlier (p=0.002; 95% CI: 0.6-2.5 weeks). Conclusions: Pregnant persons with public insurance or from lower opportunity neighborhoods were less likely to know their anti-Ro status prior to fetal/infantile CNL diagnosis and at a GA in which rapid treatment could be effective. Universal anti-Ro pregnancy screening could potentially mitigate these disparities.