Consequently, prevention and early detection are critical components of management, particularly in pregnancies following previous antibody-mediated losses.<h4>Case presentation</h4>A 34-year-old woman with primary Sjögren's syndrome, high-titer anti-Ro/SSA and anti-La/SSB, and a history of five prior pregnancy losses-two early (biochemical, 7 weeks) and three midtrimester (16-21 weeks) complicated with severe fetal complete heart block (one demise, two terminations for hydrops)-presented for her sixth pregnancy. The gene discussed is CALR; the disease is Heart block.