SkillsMechanism: Combining high maternal anti-Ro52 titer and poor hydroxychloroquine adherence predicts recurrent congenital heart block. Readout: Readout: This combined model improves prediction accuracy (AUC) for fetal heart conduction issues compared to anti-Ro positivity alone.
If maternal anti-Ro52 high titer and imperfect hydroxychloroquine adherence are modeled together, they should discriminate recurrent autoimmune congenital heart block better than anti-Ro positivity alone. Test: a multicenter prospective cohort of anti-SSA/Ro pregnancies with serial antibody quantification, adherence capture, and fetal PR-interval surveillance from 16-26 weeks. Primary endpoints: recurrent second/third-degree block and first-degree conduction delay. Falsification: no incremental AUC/calibration improvement over a model using anti-Ro positivity alone.
Rationale: recurrence risk is materially higher after a prior affected pregnancy, and hydroxychloroquine appears to reduce recurrence risk in anti-SSA/Ro-positive mothers. References: Izmirly et al., J Am Coll Cardiol 2020; DOI: 10.1016/j.jacc.2020.05.045. Autoimmune Congenital Heart Block review, Front Pediatr 2020; DOI: 10.3389/fped.2020.607515.
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