Managing SSA Antibody Positive Pregnancy: What You Need to Know

Pregnancy with positive SSA antibodies?

Hello doctor, I have a positive SSA result of 160, which has remained around this level for the past three years with no significant symptoms.
I have been regularly following up with the immunology department in Taoyuan.
Later, when I found out I was pregnant, my doctor did not prescribe any medication (originally due to the lack of symptoms).
I had a series of immune antibody tests, and only SSA was positive.
Since I am from Hsinchu, I later transferred to a hospital there.
However, when the doctor heard my SSA level of 160, he immediately prescribed quinine, stating that it could prevent the baby's heart from being affected during the second trimester.
He mentioned that usually, treatment should start as soon as pregnancy is confirmed.
I am currently 9 weeks along and feel increasingly anxious about starting the medication now, worrying that it might be too late and feeling guilty for my baby...

Yuyu, 20~29 year old female. Ask Date: 2023/08/21

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
I believe you don't need to worry too much at this stage.
The likelihood of neonatal arrhythmias in pregnant women who are SSA positive is relatively low, but it is indeed something to monitor.
Quinine is a medication and does have potential side effects; taking quinine during pregnancy carries its own risks, and the acceptability for the pregnant woman should also be considered.

Therefore, I generally make different decisions based on the woman's condition.
If there are symptoms of rheumatic disease and SSA is positive, I would discuss the necessity and risks of medication with the patient before deciding whether to proceed with treatment.
If there are no symptoms of rheumatic disease, it may be sufficient to discuss with the obstetrician and carefully monitor the fetal heart rate, using medication only if issues arise.
It is not always necessary to start medication right away.

Regardless, we will certainly support the pregnant woman throughout the child's developmental period.
Since a decision has been made to use medication, you can relax and collaborate with your obstetrician and rheumatologist.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is here to support you.

Reply Date: 2023/08/21

More Info

Managing a pregnancy while being SSA antibody positive can be a complex situation, and it is understandable to have concerns about the health of both the mother and the baby. The SSA (anti-Ro) antibodies are associated with certain autoimmune conditions, particularly Sjögren's syndrome and lupus, and they can pose risks during pregnancy, particularly regarding fetal heart health.

Firstly, it is important to understand that SSA antibodies can cross the placenta and may affect the fetus, potentially leading to congenital heart block, which is a serious condition where the heart does not beat properly. However, the actual risk of this occurring is relatively low, especially if there are no other symptoms or complications present. The presence of SSA antibodies does not automatically mean that there will be issues during pregnancy; many women with SSA positivity have healthy pregnancies and babies.

In your case, the decision to start treatment with quinine was made by your physician based on your SSA antibody levels and the potential risks associated with them. Quinine is sometimes used in this context to help manage the risk of fetal heart complications, but it is essential to weigh the benefits against the potential side effects of the medication. Quinine can have side effects, including nausea, dizziness, and in some cases, more severe reactions. Therefore, the decision to initiate treatment should be made collaboratively between you and your healthcare providers, considering your specific circumstances and any symptoms you may have.

It is also important to note that while starting treatment at 9 weeks may feel late, it is better to begin treatment now than to delay further if your healthcare team believes it is necessary. Continuous monitoring of the pregnancy is crucial, and your healthcare providers will likely recommend regular ultrasounds and fetal monitoring to check for any signs of heart block or other complications.

In addition to medication, it is vital to maintain open communication with both your obstetrician and rheumatologist. They can work together to monitor your health and the health of your baby throughout the pregnancy. Regular check-ups and tests can help catch any potential issues early, allowing for timely interventions if necessary.

Furthermore, managing stress and anxiety during pregnancy is essential. It is understandable to feel worried about your baby's health, but try to focus on the positive aspects of your pregnancy and the support you have from your healthcare team. Engaging in relaxation techniques, such as prenatal yoga or meditation, can also be beneficial for both your mental and physical well-being.

In summary, while being SSA antibody positive does carry some risks during pregnancy, many women with this condition have successful pregnancies. The decision to start treatment with quinine should be based on a thorough discussion with your healthcare providers, considering your specific situation. Regular monitoring and open communication with your medical team will be key to managing your pregnancy effectively. Remember, you are not alone in this journey, and your healthcare providers are there to support you every step of the way.

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