OC21.04: Risk based prenatal monitoring for immune mediated fetal heart disease: a prospective 5‐year experience
Bibliographic record
Abstract
Exposure of the fetus to maternal anti-Ro autoantibodies (AB) is the main etiology of congenital complete heart (CHB) and endocardial fibroelastosis (EFE). Because of the perception that these immune-mediated conditions may be preventable if treated at an early disease stage, weekly echocardiograms during the period of highest fetal risk of CHB is recommended to mothers with a positive anti-Ro AB test. In an earlier study, we found that all mothers of children with immune-mediated CHB had high anti-Ro antibody levels and concluded that serial echocardiograms should be limited to women with these high levels. This prospective study reports the utility of this approach. From 2009–2013, 239 mothers were referred for fetal echocardiography because of a positive anti-Ro AB test result in an outside lab. At the time of the first exam at 18 weeks, maternal anti-Ro sera titers were routinely measured by ELISA and classified as negative (group 1: < 8 U/ml), low-positive (group 2: 8–49 U/ml), or high-positive (group 3: ≥ 50 U/ml). Weekly echocardiograms to 24 weeks (no child with CHB) or 35 weeks (child with CHB) were only offered to group 3 mothers. Irrespective of titers, a neonatal clinical exam and ECG was recommended. Of 239 mothers, 43 tested anti-Ro negative, 63 low-positive and 133 high-positive. Immune-mediated heart disease affected 8 fetuses of group 3 mothers (6%; 8/133; p = 0.037) and included complete (n = 4) or incomplete heart block (n = 3) and isolated EFE (n = 1). Numbers of echocardiograms/mother in group 1 (1.9 ± 0.8) and group 2 (2.1 ± 1.4) were significantly less compared with group 3 (5.1 ± 3.2; p < 0.001). None of the low positive AB babies had postnatal signs of heart block. Restricting serial fetal echocardiography to women with high anti-Ro AB titers is safe. Our approach significantly reduced numbers of unnecessary fetal echocardiograms of half of our referrals. Of cases with immune-mediated cardiac complications, 50% were detected at a reversible disease stage with immediate treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".