Fetal heart involvement in diabetic mothers and positive anti SSA and/or anti SSB mothers

The incidence of congenital heart disease (CHD) is fivefold higher in infants of pregestational diabetic mothers than in controls. Ventricular septal defect (VSD), single-ventricle defects, heterotaxy, truncus arteriosus and transposition of the great arteries are more common defects. Poor control of blood sugar in the first trimester of gestation, as evidenced by an elevated glycohemoglobin level (HbA1c) is the most definitive risk factor for CHD of fetus in diabetic mother. fetal echocardiography should be performed in all women with pregestational diabetes. Gestational diabetes, which is diagnosed beyond the first trimester of pregnancy, does not increase the risk of CHD in the fetus. If the HbA1c was greater than 6% in the second trimester, fetal echocardiography in the third trimester to assess for ventricular hypertrophy is recommended for pregestational and gestational diabetic pregnancies. Congenital complete AV block (AVB) in more than 90% of affected neonates results from passage of maternal anti-Ro/SSA and/or anti-La/SSB antibodies. The mothers of these neonates are commonly diagnosed with systemic lupus erythematosus (SLE), Sjögren syndrome (SS), or other rheumatic diseases, although many are asymptomatic. Complete fetal AVB, which usually develops during gestational weeks 16 to 24, conveys a significant fetal mortality rate (15% to 30%) and morbidity; two thirds of affected offspring will require permanent pacing. early diagnosis and treatment of low grade blocks can normalize AV node function.