{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T10:29:12Z","timestamp":1789122552858,"version":"build-2803163510"},"reference-count":15,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,6,11]],"date-time":"2023-06-11T00:00:00Z","timestamp":1686441600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Anti\u2010Ro antibody\u2013positive mothers are frequently referred for serial echocardiography due to the fetal risk of developing heart block and endocardial fibroelastosis. Little is known why only some and not all offspring develop these cardiac manifestations of neonatal lupus (CNL). This prospective study examined associations between anti\u2010Ro antibody titers and fetal CNL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Antibody\u2010positive mothers referred since 2018 for fetal echocardiography at risk of CNL (group 1; n\u00a0=\u00a0240) or with CNL (group 2; n\u00a0=\u00a018) were included. Maternal antibody titers were measured with a chemiluminescent immunoassay (CIA). Additional testing on diluted serum samples was used to quantify anti\u2013Ro 60 antibody titers above the analytical measuring range (AMR) of the standard CIA (\u22651,375 chemiluminescent units [CU]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 27 total mothers with a fetal diagnosis of CNL, all displayed anti\u2013Ro 60 antibody titers that exceeded the AMR of the CIA at least 10\u2010fold. Of 122 mothers in group 1 who underwent additional anti\u2013Ro 60 antibody testing, event rates of CNL (n\u00a0=\u00a09) were 0% (0 of 45) among mothers with anti\u2013Ro 60 antibody titers from 1,375\u201310,000 CU, 5% (3 of 56) among mothers with titers from 10,000\u201350,000 CU, but 29% (6 of 21) among mothers with titers &gt;50,000 CU (odds ratio 13.1, <jats:italic>P<\/jats:italic> =\u20090.0008). Of mothers in group 2 with a primary diagnosis of CNL, 0% (0 of 18 mothers) had anti\u2013Ro 60 antibody titers &lt;10,000 CU, 44% (8 of 18 mothers) had titers from 10,000\u201350,000 CU, and 56% (10 of 18 mothers) had titers &gt;50,000 CU.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>CNL is associated with substantially higher anti\u2010Ro antibody titers than are obtained using a standard CIA. Enhancing the assay measuring range allows an improved specificity of identifying pregnancies at risk of CNL.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.42513","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T13:58:45Z","timestamp":1680184725000},"page":"1556-1565","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Maternal Anti\u2010Ro Antibody Titers Obtained With Commercially Available Immunoassays Are Strongly Associated With Immune\u2010Mediated Fetal Heart Disease"],"prefix":"10.1002","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9012-6592","authenticated-orcid":false,"given":"Edgar","family":"Jaeggi","sequence":"first","affiliation":[{"name":"Labatt Family Heart Centre, The Hospital for Sick Children University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vathany","family":"Kulasingam","sequence":"additional","affiliation":[{"name":"Division of Clinical Biochemistry, Toronto General Hospital University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine &amp; Pathobiology, The Hospital for Sick Children University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Po Steve","family":"Fan","sequence":"additional","affiliation":[{"name":"Rogers Computational Program, Ted Rogers Centre for Heart Research University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Laskin","sequence":"additional","affiliation":[{"name":"Department of Medicine Mount Sinai Hospital  New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Labatt Family Heart Centre, The Hospital for Sick Children University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6690-8148","authenticated-orcid":false,"given":"Linda T.","family":"Hiraki","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, The Hospital for Sick Children University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Earl D.","family":"Silverman","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, The Hospital for Sick Children University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lusia","family":"Sepiashvili","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine &amp; 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