In a pregnancy with a history of congenital heart block (CHB) and SSA/SSB positivity, what is indicated for the next pregnancy?

In pregnancies with a history of congenital heart block and the presence of SSA/SSB antibodies, it is essential to manage the risk of recurrence in subsequent pregnancies. Hydroxychloroquine is indicated in this scenario because it has been shown to reduce the risk of congenital heart block in fetuses from mothers with these autoantibodies. The drug can help improve maternal health and may influence the autoimmune response that is associated with the development of congenital heart block.

Research indicates that the administration of hydroxychloroquine in mothers with SSA/SSB antibodies can lower the likelihood of heart block in the offspring by potentially modulating the immune response that leads to fetal cardiac conduction disturbances.

In contrast, while folic acid supplements are generally recommended in all pregnancies to prevent neural tube defects, they do not specifically address the risks associated with SSA/SSB antibodies. Increased fetal monitoring is also prudent in high-risk pregnancies but does not alter the underlying risk mechanisms related to congenital heart block. Progesterone therapy may be beneficial in certain contexts, such as preventing preterm labor, but it does not directly influence the autoimmune risk associated with SSA/SSB antibodies. Therefore, hydroxychloroquine is the most appropriate choice in this specific context.