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Galli J, Loi E, Lazzaroni MG, Molinaro A, Andreoli L, Bendoni M, Moschetti L, Pedretti E, Visconti LM, Airò P, Franceschini F, Tincani A, Fazzi E. Neurodevelopmental profile in children born to mothers affected by systemic sclerosis. Early Hum Dev 2024; 191:105988. [PMID: 38531240 DOI: 10.1016/j.earlhumdev.2024.105988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a chronic immune-mediated connective tissue disease that can affect women of childbearing age. The long-term outcomes of their offspring remain poorly explored. Aim of this study was to detail the neurodevelopmental profile of children born to SSc mothers. METHODS Twenty children (mean age: 96 ± 4.32 months; 10 males) born to SSc mothers were enrolled. We collected data on clinical history, neurological examination, cognitive profile and adaptive behavior in all subjects. According to the chronological age, we also investigated quality of life, behavioral characteristics, psychological functioning and self-image. RESULTS All the children had normal neurological examination, cognitive profile and adaptive functioning, except for one (5 %) who suffered from Autism Spectrum Disorder. An important discrepancy was observed between parental and child opinion regarding the perception of quality of life, more compromised in the latter. We documented a risk for internalizing behavioral problems in 2 cases (10 %), for externalizing problems in 3 (15 %), for both in 1 (5 %) and for social and out-of-school activities in 5 (25 %). As regards psychological functioning, evaluated in 11 children, three (28 %) were at risk for anxiety, 1 (9 %) for depressive disorders and other 4 (36 %) for somatic disturbances. Emotional fragility and poor competence in metabolizing one's emotional experiences were observed in 9 out of the 13 subjects assessed (70 %). CONCLUSIONS Children born to SSc women exhibit normal cognitive and adaptive abilities but an increased vulnerability to psychopathological problems and fragility in social functioning. These observations might reflect that children need to feel mature to accept maternal chronic disease that, in turn, may hinder support for offspring's social and emotional development.
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Affiliation(s)
- Jessica Galli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Erika Loi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Maria Grazia Lazzaroni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili of Brescia, Italy
| | - Anna Molinaro
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili of Brescia, Italy
| | - Marzia Bendoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Liala Moschetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili of Brescia, Italy
| | - Eleonora Pedretti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili of Brescia, Italy
| | | | - Paolo Airò
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili of Brescia, Italy
| | - Franco Franceschini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili of Brescia, Italy
| | - Angela Tincani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili of Brescia, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
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Gris JC, Guillotin F, Chéa M, Bourguignon C, Nouvellon É, Bouvier S. Antiphospholipid Antibodies in Pregnancy: Maternal and Neonatal Implications. Semin Thromb Hemost 2022; 49:337-347. [PMID: 36108650 DOI: 10.1055/s-0042-1756193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AbstractAntiphospholipid antibodies (aPL Abs) have long been associated with the occurrence of certain specific pregnancy morbidities, affecting both mother and fetus. Antithrombotic-based prophylactic regimens are the standard of care. Their intensity is modulated by the thrombotic history and has greatly improved the prognosis related to spontaneous morbidity. Observational studies show that this treatment is still associated with the persistence of excess of late-pregnancy placental diseases, calling for new or complementary developments, yet to be validated. Rigorous prospective multicentric validation of clinical and laboratory parameters capable of identifying those women and fetuses at a risk of pejorative evolution, thus early prognosis, is a priority issue. These will make it possible to develop customized treatments and test them. Furthermore, there are still concerns, particularly neurodevelopmental ones, about children born to aPL Ab-positive mothers, and clarification based on regular, more systematic evaluations is required. Even after pregnancy, women with a pure obstetrical antiphospholipid syndrome are at a greater risk of venous and arterial thrombosis over time, and prevention needs to be improved. These women also appear to develop more psychiatric and mood disorders. Central nervous system imaging using high-resolution techniques has shown subtle impairments in the white matter, associated with the most pathogenic aPL Abs and the clinical significance of this is under investigation. These mothers also seem to develop an excess of cancers. The systemic impact of aPL Abs is gradually being suspected, although this requires further evidence, and prevention should be envisaged.
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Affiliation(s)
- Jean-Christophe Gris
- Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
- Department of Hematology, Faculty of Pharmaceutical and Biological Sciences, Montpellier University, France
- UMR UA11 INSERM IDESP - Montpellier University, France
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | - Mathias Chéa
- Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Chloé Bourguignon
- Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
- UMR UA11 INSERM IDESP - Montpellier University, France
| | - Éva Nouvellon
- Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
- UMR UA11 INSERM IDESP - Montpellier University, France
| | - Sylvie Bouvier
- Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
- Department of Hematology, Faculty of Pharmaceutical and Biological Sciences, Montpellier University, France
- UMR UA11 INSERM IDESP - Montpellier University, France
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3
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Gris JC, Guillotin F, Chéa M, Fortier M, Bourguignon C, Mercier É, Bouvier S. Antiphospholipid syndrome in pregnancy: Neuro-psychiatric aspects. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2021.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Knudsen SS, Simard JF, Christensen J, Laursen TM, Deleuran BW, Bech BH. Association of Rheumatoid Arthritis in Pregnancy With School Performance of Offspring: A Danish Nationwide Register-Based Study. Arthritis Care Res (Hoboken) 2021; 73:975-982. [PMID: 32339372 DOI: 10.1002/acr.24223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the overall cognitive development of children exposed to maternal rheumatoid arthritis (RA) in utero by comparing their school test scores to those of their peers. METHODS Children born in Denmark during 1995-2008 and listed in the National School Test Register were included (n = 738,862). Children exposed to maternal RA were identified through linkage of national registers. In separate analyses, exposure was subdivided according to maternal serostatus. Preclinical maternal RA was included as a separate exposure. The Danish national school tests are mandatory standardized tests. Results from all reading tests (grades 2, 4, 6, and 8) and mathematics tests (grades 3 and 6) from 2010-2017 were included. Test scores were compared according to maternal RA exposure for each test separately using linear regressions. RESULTS We identified 934 children exposed to maternal RA in utero. There were no differences in reading test scores between maternal RA exposed and unexposed children. RA exposed children scored poorer in both mathematics tests (adjusted differences of mean score -0.14 SD (95% confidence interval [95% CI] -0.23, -0.06) and -0.16 SD (95% CI -0.26, -0.07). There was no appreciable difference between children by maternal RA serostatus. Children exposed to preclinical RA (n = 589) showed the same pattern of performance as children exposed to RA. CONCLUSION RA-exposed children scored slightly poorer in mathematics tests but performed as well as their unexposed peers in the reading tests. The results do not suggest that RA in pregnancy has a major impact on offspring school performance.
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Affiliation(s)
- Signe S Knudsen
- Aarhus University and Aarhus University Hospital, Aarhus, Denmark, and Stanford Medicine, Stanford, California
| | | | | | | | - Bent W Deleuran
- Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Taulaigo AV, Moschetti L, Ganhão S, Gerardi MC, Franceschini F, Tincani A, Andreoli L. Safety considerations when using drugs in pregnant patients with systemic lupus erythematosus. Expert Opin Drug Saf 2021; 20:523-536. [PMID: 33599570 DOI: 10.1080/14740338.2021.1893298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Systemic lupus erythematosus (SLE) mainly affects young females during childbearing age; therefore, reproductive issues are of major interest.Areas covered: Pregnancy planning is crucial to adjust the treatment toward drugs that are safe throughout pregnancy and breastfeeding. The evidence about drug safety is limited to post-marketing surveillance, registries, case series, and case reports, as pregnant patients are excluded from randomized clinical trials. The aim of this review is to report the safety considerations when treating pregnant SLE patients. Regarding maternal side effects of drugs, we focused on metabolic, infectious, and hemorrhagic complications. Fetal safety was analyzed looking at drugs teratogenicity, their possible effects on immune system, and on the long-term neuropsychological development of children.Expert opinion: The management of pregnancy in SLE has changed when knowledge about the safety of drugs has become available. Keeping SLE disease activity under control before, during and after pregnancy is of fundamental importance to ensure the best possible outcomes for mother and child. All these issues must be discussed with the patient and her family during preconception counseling. International efforts in terms of pregnancy registries and reproductive health guidelines help physicians improve their communication with SLE patients.
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Affiliation(s)
- Anna Viola Taulaigo
- Unidade De Doenças Auto-imunes/Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário De Lisboa Central, Lisboa, Portugal
| | - Liala Moschetti
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sara Ganhão
- Rheumatology Department, Centro Hospitalar E Universitário De São João, Porto, Portugal
| | - Maria-Chiara Gerardi
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Franceschini
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Tincani
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Shimada H, Kameda T, Kanenishi K, Miyatake N, Nakashima S, Wakiya R, Kato M, Miyagi T, Mansour MMF, Hata T, Kadowaki N, Dobashi H. Factors affecting the Apgar score of offsprings born to mothers suffering from systemic lupus erythematosus. Medicine (Baltimore) 2020; 99:e22843. [PMID: 33120814 PMCID: PMC7581183 DOI: 10.1097/md.0000000000022843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To reveal which disease activity parameters affect low Apgar scores of newborns, which is considered as a predictive parameter for neurological development.We examined retrospectively the data from 42 newborns who were delivered from systemic lupus erythematosus (SLE) mothers from 2006 to 2019. We evaluated whether the disease activity parameters, such as the achievement ratio of lupus low disease activity state (LLDAS), SLE disease activities index (SLEDAI), complement level, titer of anti-double stranded DNA (anti-dsDNA) antibody, therapeutic agents were related with low Apgar scores of newborns.In 42 newborns, adverse pregnancy outcomes, especially preterm birth (16.7%), low birth weight (31.0%) light-for-date (11.9%) were associated with disease activity parameters or prednisolone dose. Apgar scores at 1 minute were related with unachieved LLDAS and the titer of anti-dsDNA antibody at first and third trimester, SLEDAI score and complement level at third trimester, mean prednisolone dose. Apgar scores at 5 minutes were also associated with the titer of anti-dsDNA antibodies at first and third trimester and mean prednisolone dose. Multivariate analysis showed only high titer of anti-dsDNA antibody was significantly associated with low Apgar score at both one minute and 5 minutes.In our retrospective study, high titer of anti-dsDNA antibodies at first and third trimester was a risk factor for low Apgar scores of newborns born to SLE mothers. We considered that high titer of anti-dsDNA antibody influenced on childrens neurological development, therefore, there is a need for long-term follow-up study of SLE offsprings.
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Affiliation(s)
- Hiromi Shimada
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine
| | - Tomohiro Kameda
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine
| | | | - Nobuyuki Miyatake
- Department of Hygiene, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shusaku Nakashima
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine
| | - Risa Wakiya
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine
| | - Mikiya Kato
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine
| | - Taichi Miyagi
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine
| | | | | | - Norimitsu Kadowaki
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine
| | - Hiroaki Dobashi
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine
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7
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Bitsadze V, Nalli C, Khizroeva J, Lini D, Andreoli L, Lojacono A, Fazzi E, Shoenfeld Y, Tincani A, Makatsariya A. "APS pregnancy - The offspring". Lupus 2020; 29:1336-1345. [PMID: 32752918 DOI: 10.1177/0961203320947154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Antiphospholipid antibody syndrome (APS) is an autoimmune disease that affects women in childbearing age. In recent years, great improvements were achieved in the management of pregnancies in these women. Prematurity could be an issue in these pregnancies, mainly due to the direct pathogenic effect of antiphospholipid antibodies (aPL) on the placental surface. Maternal IgG aPL can cross the placenta and theoretically interact with the growing fetus; it could reach the fetal brain because of the incompleteness of the fetal blood-brain barrier: whether this can have an effect on brain development is still debated. Neonatal thrombosis episodes have been described in children positive for aPL, not always associated with maternal antibody positivity, suggesting the hypothesis of a possible aPL de novo synthesis in fetus and neonates. METHODS A keyword-based literature search was conducted. We also described a case of neonatal catastrophic antiphospholipid syndrome (CAPS). RESULTS Offspring of patients with APS are generally healthy but the occurrence of neonatal thrombosis or minor neurological disorders were reported. CONCLUSIONS The limited number of the available data on this sensitive issue supports the need for further studies. Clinical follow-up of children of mothers with APS seems to be important to exclude, in the neonatal period, the occurrence of aPL associated pathological events such as thrombosis, and in the long-term, impairment in learning skills or behavioral problems.
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Affiliation(s)
- Viktoria Bitsadze
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Cecilia Nalli
- Rheumatology and Immunology Unit, ASST Spedali Civili, Brescia, Italy
| | - Jamilya Khizroeva
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Daniele Lini
- Rheumatology and Immunology Unit, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Immunology Unit, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Lojacono
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Obstetric and Gynecology Unit, ASST Spedali Civili, Brescia, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Child Neurology and Psychiatry Unit, ASST Spedali Civili, Brescia, Italy
| | - Yehuda Shoenfeld
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.,Department of Medicine 'B', The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Angela Tincani
- Rheumatology and Immunology Unit, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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8
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Belizna C, Meroni PL, Shoenfeld Y, Devreese K, Alijotas-Reig J, Esteve-Valverde E, Chighizola C, Pregnolato F, Cohen H, Fassot C, Mattera PM, Peretti P, Levy A, Bernard L, Saiet M, Lagarce L, Briet M, Rivière M, Pellier I, Gascoin G, Rakotonjanahary J, Borghi MO, Stojanovich L, Djokovic A, Stanisavljevic N, Bromley R, Elefant-Amoura E, Bahi Buisson N, Pindi Sala T, Kelchtermans H, Makatsariya A, Bidsatze V, Khizroeva J, Latino JO, Udry S, Henrion D, Loufrani L, Guihot AL, Muchardt C, Hasan M, Ungeheuer MN, Voswinkel J, Damian L, Pabinger I, Gebhart J, Lopez Pedrera R, Cohen Tervaert JW, Tincani A, Andreoli L. In utero exposure to Azathioprine in autoimmune disease. Where do we stand? Autoimmun Rev 2020; 19:102525. [PMID: 32240856 DOI: 10.1016/j.autrev.2020.102525] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/19/2022]
Abstract
Azathioprine (AZA), an oral immunosuppressant, is safe during pregnancy. Some reports suggested different impairments in the offspring of mothers with autoimmune diseases (AI) exposed in utero to AZA. These observations are available from retrospective studies or case reports. However, data with respect to the long-term safety in the antenatally exposed child are still lacking. The aim of this study is to summarize the current knowledge in this field and to focus on the need for a prospective study on this population. We performed a PubMed search using several search terms. The actual data show that although the risk of congenital anomalies in offspring, as well as the infertility risk, are similar to those found in general population, there is a higher incidence of prematurity, of lower weight at birth and an intra-uterine delay of development. There is also an increased risk of materno- fetal infections, especially cytomegalovirus infection. Some authors raise the interrogations about neurocognitive impairment. Even though the adverse outcomes might well be a consequence of maternal illness and disease activity, interest has been raised about a contribution of this drug. However, the interferences between the external agent (in utero exposure to AZA), with the host (child genetic susceptibility, immune system anomalies, emotional status), environment (public health, social context, availability of health care), economic, social, and behavioral conditions, cultural patterns, are complex and represent confounding factors. In conclusion, it is necessary to perform studies on the medium and long-term outcome of children born by mothers with autoimmune diseases, treated with AZA, in order to show the safety of AZA exposure. Only large-scale population studies with long-term follow-up will allow to formally conclude in this field. TAKE HOME MESSAGES.
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Affiliation(s)
- Cristina Belizna
- Vascular and Coagulation Department, University Hospital Angers, Angers, France; MITOVASC institute and CARFI facility, University of Angers, UMR CNRS 6015, INSERM U1083, Angers, France; Internal Medicine Department, Clinique de l'Anjou, Angers, France; UMR CNRS 6015, Angers, France; INSERM U1083, Angers, France.
| | - Pier Luigi Meroni
- Clinical Immunology and Rheumatology Research Department Auxologico Institute, Milan, Italy
| | - Yehuda Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Israel; I.M. Sechenow First Moscow State Medical University, Moscow, Russia
| | - Katrien Devreese
- Coagulation Laboratory, Department of Clinical Biology, Immunology and Microbiology, Ghent University Hospital, Ghent, Belgium
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Medicine, Universitat Autonòma, Barcelona, Spain
| | | | - Cecilia Chighizola
- Clinical Immunology and Rheumatology Research Department Auxologico Institute, Milan, Italy
| | - Francesca Pregnolato
- Clinical Immunology and Rheumatology Research Department Auxologico Institute, Milan, Italy
| | - Hannah Cohen
- Haematology Department, University College Hospital, London, UK
| | - Celine Fassot
- Internal Medicine Department, Clinique de l'Anjou, Angers, France
| | - Patrick Martin Mattera
- Faculty of Human and Social Sciences, Laboratory of Research in Psychopathology, 3 place André Leroy, 49008 Angers, France
| | - Pascale Peretti
- Faculty of Human and Social Sciences, Laboratory of Research in Psychopathology, 3 place André Leroy, 49008 Angers, France
| | - Alexandre Levy
- Faculty of Human and Social Sciences, Laboratory of Research in Psychopathology, 3 place André Leroy, 49008 Angers, France
| | - Laurence Bernard
- Faculty of Human and Social Sciences, Laboratory of Research in Psychopathology, 3 place André Leroy, 49008 Angers, France
| | - Mathilde Saiet
- Faculty of Human and Social Sciences, Laboratory of Research in Psychopathology, 3 place André Leroy, 49008 Angers, France
| | - Laurence Lagarce
- Departement of Pharmacovigilance, University Hospital Angers, Angers, France
| | - Marie Briet
- Departement of Pharmacovigilance, University Hospital Angers, Angers, France
| | - Marianne Rivière
- French Lupus and Other Autoimmune Disease Patients Association, AFL+, Cuvry, France
| | - Isabelle Pellier
- Department of Pediatrics, University Hospital Angers, Angers, France
| | - Géraldine Gascoin
- Department of Neonatology, University Hospital Angers, Angers, France
| | | | - Maria Orietta Borghi
- Clinical Immunology and Rheumatology Research Department Auxologico Institute, Milan, Italy
| | - Ljudmila Stojanovich
- Scientific Research Department, Internal Medicine-Rheumatology Bezhanijska Kosa, University Medical Center, Belgrade University, Serbia
| | - Aleksandra Djokovic
- Scientific Research Department, Internal Medicine-Rheumatology Bezhanijska Kosa, University Medical Center, Belgrade University, Serbia
| | - Natasa Stanisavljevic
- Scientific Research Department, Internal Medicine-Rheumatology Bezhanijska Kosa, University Medical Center, Belgrade University, Serbia
| | - Rebecca Bromley
- Manchester University Hospitals NHS Trust, Manchester, UK; Division of Evolution and Genomic Science, School of Biological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Elisabeth Elefant-Amoura
- Genetical and Medical Embriology, CRAT Reference Center on Teratogenic Agents, Paris Est - Hôpital d'Enfants Armand-Trousseau, 26 avenue du Docteur Arnold Netter, 75571 Paris, France
| | - Nadia Bahi Buisson
- Neurology & Neurodevelopmental disorders Department Necker Enfants Malades University Hospital, APHP, Paris 149 Rue de Sèvres, 75015 Paris; INSERM U1163, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France; INSERM U1163, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Taylor Pindi Sala
- EA 7334, Patient Centered Outcomes Research, University Paris Diderot, Paris, France
| | - Hilde Kelchtermans
- Synapse Research Institute, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, I.M. Sechenow First Moscow State Medical University, Moscow, Russia
| | - Viktoria Bidsatze
- Department of Obstetrics and Gynecology, I.M. Sechenow First Moscow State Medical University, Moscow, Russia
| | - Jamilya Khizroeva
- Department of Obstetrics and Gynecology, I.M. Sechenow First Moscow State Medical University, Moscow, Russia
| | - Jose Omar Latino
- Autoimmune and thrombophilic disorders Department, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Sebastian Udry
- Autoimmune and thrombophilic disorders Department, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Daniel Henrion
- Internal Medicine Department, Clinique de l'Anjou, Angers, France
| | - Laurent Loufrani
- Internal Medicine Department, Clinique de l'Anjou, Angers, France
| | | | - Christian Muchardt
- Unit of Epigenetic Regulation, Department of Developmental and Stem Cell Biology, UMR3738 CNRS, Institut Pasteur, Paris, France
| | - Milena Hasan
- Cytometry and Biomarkers Unit of Technology and Service, Center for Translational Science, Institut Pasteur, 28, Rue Doct Roux, 75015 Paris, France
| | - Marie Noelle Ungeheuer
- Clinical Investigation and Acces to Bioresources Department, Institut Pasteur, 28, Rue Doct Roux, 75015 Paris, France
| | - Jan Voswinkel
- Department of Internal Medicine I, Saarland Medical School, University of Saarland, Homburg, Saarland, Germany
| | - Laura Damian
- Department of Rheumatology, County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Ingrid Pabinger
- Department of Medicine, Division of Hematology and Haemostasis, University Hospital of Vienna, Austria
| | - Johanna Gebhart
- Department of Medicine, Division of Hematology and Haemostasis, University Hospital of Vienna, Austria
| | - Rosario Lopez Pedrera
- Institute Maimónides of Biomedical Investigations, University Hospital Reina Sofía, Cordoba, Spain
| | | | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, University of Brescia, Brescia, Italy; I.M. Sechenow First Moscow State Medical University, Moscow, Russia
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, University of Brescia, Brescia, Italy
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Abstract
PURPOSE OF REVIEW The purpose of this report is to review recent research findings on APS in children and neonates. RECENT FINDINGS European evidence-based recommendations for diagnosis and treatment of pediatric APS has recently been published by the SHARE Initiative. Recent studies have shown a high prevalence of non-thrombotic manifestations in children with aPL, domains 4/5 specificity of 'innocent' anti-β2GPI antibodies in infants, and a higher risk for developmental delays and learning disabilities, hence, the need for neurodevelopmental monitoring in children born to mothers with APS. An International effort on creating a new diagnostic criteria for APS is underway. Pediatric APS is a rare disease with significant differences from the APS in adults. Majority of the children with persistently positive aPL do not develop thrombotic events; however, relatively higher proportion of thrombosis in children is related to aPL positivity compared to adults; this may partly be due to the absence of common pro-thrombotic "second-hit" risk factors of adults such as atherosclerosis and cigarette smoking. Diagnosis of APS in children may be delayed or missed when adult APS criteria are used, because in pediatric APS, non-thrombotic clinical manifestations such as thrombocytopenia, hemolytic anemia, and neurological disorders such as migraine, epilepsy, and chorea may precede thrombotic manifestations. Around 20% of the children initially diagnosed with primary APS eventually develop SLE. Neonatal APS is rare; however, the offspring of mothers with APS are at a higher risk for developmental delays and learning disabilities; prematurity and IUGR may increase this risk. Regular assessment of neurodevelopmental status of these children should be performed. Thrombosis is a rare event in the offspring of mothers with APS; anticoagulation of such infants is not recommended. An international effort to create a new diagnostic criteria for APS is underway.
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Affiliation(s)
- Arzu Soybilgic
- Pediatric Rheumatology, Children's Hospital of University of Illinois, 840 S. Wood St, 1206 CSB, Chicago, 60612, USA.
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center, Faculty of Medicine, University of Ljubljana, Bohoriceva 20, 1525, Ljubljana, Slovenia
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10
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Antovic A, Sennström M, Bremme K, Svenungsson E. Obstetric antiphospholipid syndrome. Lupus Sci Med 2018; 5:e000197. [PMID: 30364418 PMCID: PMC6195166 DOI: 10.1136/lupus-2016-000197] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022]
Abstract
The present clinical and laboratory classification criteria for antiphospholipid syndrome (APS) were established in Sydney, Australia, in 2006. In this review, we focus on the obstetric subset of APS (OAPS), defined by persistent positivity for antiphospholipid antibodies together with either early recurrent pregnancy loss, early fetal death, stillbirth or premature birth <34 gestational weeks due to pre-eclampsia, eclampsia and placental insufficiency. It is important to diagnose these cases since most women suffering from OAPS can, when given appropriate treatment, have successful pregnancies. Furthermore, patients with OAPS may, depending on the antibody profile, be at enhanced risk of thrombotic events later in life. We present an update on the present knowledge of possible underlying pathogenesis, risk factors and risk estimations for adverse pregnancy outcomes before and during pregnancy, current treatment concepts, and long-term outcomes for women with OAPS and their children.
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Affiliation(s)
- Aleksandra Antovic
- Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Maria Sennström
- Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Bremme
- Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabet Svenungsson
- Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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11
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Cavazzana I, Andreoli L, Limper M, Franceschini F, Tincani A. Update on Antiphospholipid Syndrome: Ten Topics in 2017. Curr Rheumatol Rep 2018. [DOI: 10.1007/s11926-018-0718-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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12
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Hwang JK, Park HK, Sung YK, Hoh JK, Lee HJ. Maternal outcomes and follow-up of preterm and term neonates born to mothers with systemic lupus erythematosus. J Matern Fetal Neonatal Med 2017; 31:7-13. [DOI: 10.1080/14767058.2016.1205027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jae-Kyoon Hwang
- Department of Pediatrics, Hanyang University Hospital for Rheumatic Diseases Clinical Research Center for Rheumatoid Arthritis, Seoul, Republic of Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University Hospital for Rheumatic Diseases Clinical Research Center for Rheumatoid Arthritis, Seoul, Republic of Korea
| | | | - Jeong-Kyu Hoh
- Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University Hospital for Rheumatic Diseases Clinical Research Center for Rheumatoid Arthritis, Seoul, Republic of Korea
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13
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Nalli C, Iodice A, Andreoli L, Galli J, Lojacono A, Motta M, Fazzi E, Tincani A. Long-term neurodevelopmental outcome of children born to prospectively followed pregnancies of women with systemic lupus erythematosus and/or antiphospholipid syndrome. Lupus 2017; 26:552-558. [DOI: 10.1177/0961203317694960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS) are autoimmune diseases that affect women of childbearing age. Maternal IgG antiphospholipid antibodies (aPL) can cross the placenta during pregnancy and theoretically reach the fetal brain. Some studies showed an increased number of learning disabilities in these children. Objectives To evaluate the long-term neurodevelopmental outcome of 40 children (median age 7.4 years) born to mothers with SLE and/or APS carrying positive IgG aPL during the third trimester of pregnancy. Methods Children were checked for neurological physical exam and intellectual/cognitive functioning by the Wechsler scale for corrected age. We submitted to the mothers the Child Behavior CheckList (CBCL) and a homemade set of questions created by pediatric neurologists. Results In all children neurological physical exam and intelligence levels were found to be normal. A cognitive impairment or a discrepant cognitive profile was found in 3 (7%) and 11 (28%) children, respectively. Learning disabilities were diagnosed in 3 children (19% of school-age children), all born to mothers with triple aPL positivity. A history of epilepsy was shown in four children (10%). Conclusions: Children born to women with SLE and/or APS may need a long-term follow-up focusing on milestones of neurodevelopment in order to detect and correct any alteration as early as possible.
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Affiliation(s)
- C Nalli
- Rheumatology and Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - A Iodice
- Child Neuropsychiatry Unit, Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy
| | - L Andreoli
- Rheumatology and Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - J Galli
- Unit of Child and Adolescent Neuropsychiatry, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - A Lojacono
- Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Italy
| | - M Motta
- Neonatology and NICU, ASST Spedali Civili, Brescia, Italy
| | - E Fazzi
- Unit of Child and Adolescent Neuropsychiatry, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - A Tincani
- Rheumatology and Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
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14
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Abstract
Antiphospholipid syndrome (APS) is a multisystem autoimmune condition characterized by vascular thromboses associated with persistently positive antiphospholipid antibodies. There is currently a paucity of data (incidence, prevalence, thrombosis risk, and effective treatment) in pediatric APS. The purpose of this report is to review the current literature on APS in children and neonates, identify the gaps in current knowledge, and suggest avenues for studies to fill those gaps.
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15
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Lageix F, Nicaise-Roland P, Houlier M, Zylberberg P, Dubrel M, Heulin M, Fain O, Lachassinne E, Héron B, Chollet-Martin S, Mekinian A, de Pontual L. Lien entre trouble du spectre autistique de l’enfant et anticorps antiphospholipides : une étude cas–témoin. Arch Pediatr 2015; 22:1140-6. [DOI: 10.1016/j.arcped.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/24/2015] [Accepted: 08/18/2015] [Indexed: 12/18/2022]
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16
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Jasoni CL, Sanders TR, Kim DW. Do all roads lead to Rome? The role of neuro-immune interactions before birth in the programming of offspring obesity. Front Neurosci 2015; 8:455. [PMID: 25691854 PMCID: PMC4315034 DOI: 10.3389/fnins.2014.00455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/23/2014] [Indexed: 12/20/2022] Open
Abstract
The functions of the nervous system can be powerfully modulated by the immune system. Although traditionally considered to be quite separate, neuro-immune interactions are increasingly recognized as critical for both normal and pathological nervous system function in the adult. However, a growing body of information supports a critical role for neuro-immune interactions before birth, particularly in the prenatal programming of later-life neurobehavioral disease risk. This review will focus on maternal obesity, as it represents an environment of pathological immune system function during pregnancy that elevates offspring neurobehavioral disease risk. We will first delineate the normal role of the immune system during pregnancy, including the role of the placenta as both a barrier and relayer of inflammatory information between the maternal and fetal environments. This will be followed by the current exciting findings of how immuno-modulatory molecules may elevate offspring risk of neurobehavioral disease by altering brain development and, consequently, later life function. Finally, by drawing parallels with pregnancy complications other than obesity, we will suggest that aberrant immune activation, irrespective of its origin, may lead to neuro-immune interactions that otherwise would not exist in the developing brain. These interactions could conceivably derail normal brain development and/or later life function, and thereby elevate risk for obesity and other neurobehavioral disorders later in the offspring's life.
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Affiliation(s)
- Christine L Jasoni
- Department of Anatomy, Centre for Neuroendocrinology, Gravida: National Centre for Growth and Development, University of Otago Dunedin, New Zealand
| | - Tessa R Sanders
- Department of Anatomy, Centre for Neuroendocrinology, Gravida: National Centre for Growth and Development, University of Otago Dunedin, New Zealand
| | - Dong Won Kim
- Department of Anatomy, Centre for Neuroendocrinology, Gravida: National Centre for Growth and Development, University of Otago Dunedin, New Zealand
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17
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Nalli C, Iodice A, Andreoli L, Lojacono A, Motta M, Fazzi E, Tincani A. The effects of lupus and antiphospholipid antibody syndrome on foetal outcomes. Lupus 2014; 23:507-17. [PMID: 24763535 DOI: 10.1177/0961203313501402] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease that primarily affects women of childbearing-age. Antiphospholipid syndrome (APS) is a systemic autoimmune disorder defined by the occurrence of venous and arterial thrombosis, often multiple, and pregnancy morbidity in the presence of antiphospholipid antibodies (aPL). Recently, the long-term outcome of children born to patients with lupus and APS has become a major topic of interest both to patients and physicians. One of the major problems related to maternal disease is preterm delivery with all the consequences that this condition may bring. Prematurity may also be due to the presence of aPL; however, aPL do not generally display any thrombotic potential on neonates. Another complication may be neonatal lupus (NL), mediated by the presence of maternal antibodies (anti-Ro/SSA and anti-La/SSB). In addition, behaviour and neuropsychological outcomes have also been a matter of interest, but there are currently few data available. Beyond the biological influence of both maternal disease and autoimmune background, it is important to focus on the possible influence of maternal chronic illness on the neuropsychological development of her children. Whether aPL exposure could have a direct effect on brain development is still being debated. In children of mothers with APS, language delays have been noted and learning disabilities were described with a higher rate than the general age-school population. Several studies were performed on children born to lupus mothers: even if maternal lupus does not seem to impair intelligence levels, it may increase the occurrence of learning disabilities and particularly dyslexia in male children. To the best of our knowledge, no studies are available on the long-term outcome of children born to mothers with lupus or APS and particularly regarding the development of autoimmune diseases. Nevertheless, common experience of experts in the field is that these children do not show a significantly increased risk of displaying the same autoimmune disease as their mothers. The purpose of this paper is to answer the frequently asked questions of patients with lupus and APS who desire to become mothers, based on the little information available.
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Affiliation(s)
- C Nalli
- 1Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, Italy
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18
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Sammaritano LR, Lockshin MD. Lupus science and medicine: dialogue. Lupus Sci Med 2014; 1:e000048. [PMID: 25379196 PMCID: PMC4213831 DOI: 10.1136/lupus-2014-000048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/03/2014] [Indexed: 11/04/2022]
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19
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Nalli C, Iodice A, Andreoli L, Lojacono A, Motta M, Fazzi E, Tincani A. Children born to SLE and APS mothers. Lupus 2014; 23:1246-8. [DOI: 10.1177/0961203314538109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS) are autoimmune diseases that affect women of childbearing age. Pregnancies in these patients carry several complications such as prematurity. Maternal IgG antiphospholipid antibodies (aPL) can cross the placenta but they don’t generally cause any neonatal thrombotic event. Because of the incompleteness of the fetal blood-brain barrier, aPL could theoretically reach the fetal brain. Whether this can have an effect on brain development is still under investigation. Some studies performed in children of patients with SLE and/or APS showed an increased number of learning disabilities without impairment in intelligence level. Objectives The objectives of this article are to evaluate the neurodevelopment outcome in 30 children (median age 9 years) born to mothers with SLE and/or APS with IgG anti-beta2-glycoprotein I during the third trimester of pregnancy and found positive for the same antibodies at birth. Methods A neurological physical exam was performed in all children. We submitted some questionnaires to the mothers: the Child Behavior CheckList (CBCL) and a homemade set of questions obtained by a team composed of rheumatologists and pediatric neurologists. Intellectual functioning was determined by the Wechsler scale for corrected age. Results In all children neurological physical exam and intelligence levels were found to be normal but mild behavior disorders and history of neurological manifestations were shown in three children. Conclusions Offspring of patients with SLE and/or APS are generally healthy. We and others observed the occurrence of minor neurological disorders that might be related to maternal disease or to prematurity. The limited number of the available data on this sensitive issue supports the need for further studies.
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Affiliation(s)
- C Nalli
- Rheumatology and Clinical Immunology
| | - A Iodice
- Unit of Child and Adolescent Neuropsychiatry
| | | | - A Lojacono
- Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, Italy
| | - M Motta
- Neonatology and NICU, Spedali Civili, Brescia, Italy
| | - E Fazzi
- Unit of Child and Adolescent Neuropsychiatry
| | - A Tincani
- Rheumatology and Clinical Immunology
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20
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Marder W, Romero VC, Ganser MA, Hyzy MA, Gordon C, McCune WJ, Somers EC. Increased usage of special educational services by children born to mothers with systemic lupus erythematosus and antiphospholipid antibodies. Lupus Sci Med 2014; 1:e000034. [PMID: 25379194 PMCID: PMC4213825 DOI: 10.1136/lupus-2014-000034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/20/2014] [Accepted: 06/22/2014] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Surveys of long-term health and developmental outcomes of children born to mothers with systemic lupus erythematosus (SLE) have suggested an increase in learning disabilities among these children. We performed this observational study to investigate the relationship between maternal autoantibodies and antiphospholipid antibody syndrome (APS) in maternal lupus patients and neurocognitive development among their offspring. METHODS SLE mothers with at least one live birth postlupus diagnosis were enrolled. Data on maternal medical/obstetric history and children's perinatal/medical history were collected by structured interview and medical record reviews. The primary outcome was requirement for special educational (SE) services, a proxy for developmental delays. Multiple logistic regression modelling was used to examine associations between APS and autoantibodies with SE usage, accounting for SLE disease severity and potential confounders. RESULTS Data on 38 mothers and 60 offspring were analysed: SE service usage was reported for 15 of 60 (25%) offspring. Maternal APS history was significantly associated with increased use of SE services among offspring, including after adjustment for lupus anticoagulant (LA) positivity and potential confounders (OR 5.5-9.4 for delays age ≥2; p<0.05). The presence of LA, but not other antiphospholipid antibodies, was also associated with increased SE services usage. CONCLUSIONS Maternal APS and LA were independently associated with increased usage of special educational services among offspring of women with SLE.
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Affiliation(s)
- Wendy Marder
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vivian C Romero
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Martha A Ganser
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Margaret A Hyzy
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Caroline Gordon
- School of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - W J McCune
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily C Somers
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
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21
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Vinet É, Pineau CA, Clarke AE, Fombonne É, Platt RW, Bernatsky S. Neurodevelopmental disorders in children born to mothers with systemic lupus erythematosus. Lupus 2014; 23:1099-104. [PMID: 24969080 DOI: 10.1177/0961203314541691] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Children born to women with systemic lupus erythematosus seem to have a potentially increased risk of neurodevelopmental disorders compared to children born to healthy women. Recent experimental data suggest in utero exposure to maternal antibodies and cytokines as important risk factors for neurodevelopmental disorders. Interestingly, women with systemic lupus erythematosus display high levels of autoantibodies and cytokines, which have been shown, in animal models, to alter fetal brain development and induce behavioral anomalies in offspring. Furthermore, subjects with systemic lupus erythematosus and neurodevelopmental disorders share a common genetic predisposition, which could impair the fetal immune response to in utero immunologic insults. Moreover, systemic lupus erythematosus pregnancies are at increased risk of adverse obstetrical outcomes and medication exposures, which have been implicated as potential risk factors for neurodevelopmental disorders. In this article, we review the current state of knowledge on neurodevelopmental disorders and their potential determinants in systemic lupus erythematosus offspring.
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Affiliation(s)
- É Vinet
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada Division of Rheumatology, McGill University Health Centre, Montreal, Canada
| | - C A Pineau
- Division of Rheumatology, McGill University Health Centre, Montreal, Canada
| | - A E Clarke
- Division of Rheumatology, University of Calgary, Calgary, Canada
| | - É Fombonne
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA
| | - R W Platt
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
| | - S Bernatsky
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada Division of Rheumatology, McGill University Health Centre, Montreal, Canada
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Obstetric antiphospholipid syndrome: a recent classification for an old defined disorder. Autoimmun Rev 2014; 13:901-8. [PMID: 24820522 DOI: 10.1016/j.autrev.2014.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 04/18/2014] [Indexed: 12/11/2022]
Abstract
Obstetric antiphospholipid syndrome (APS) is now being recognized as a distinct entity from vascular APS. Pregnancy morbidity includes >3 consecutive and spontaneous early miscarriages before 10weeks of gestation; at least one unexplained fetal death after the 10th week of gestation of a morphologically normal fetus; a premature birth before the 34th week of gestation of a normal neonate due to eclampsia or severe pre-eclampsia or placental insufficiency. It is not well understood how antiphospholipid antibodies (aPLs), beyond their diagnostic and prognostic role, contribute to pregnancy manifestations. Indeed aPL-mediated thrombotic events cannot explain the obstetric manifestations and additional pathogenic mechanisms, such as a placental aPL mediated complement activation and a direct effect of aPLs on placental development, have been reported. Still debated is the possible association between aPLs and infertility and the effect of maternal autoantibodies on non-vascular manifestations in the babies. Combination of low dose aspirin and unfractionated or low molecular weight heparin is the effective treatment in most of the cases. However, pregnancy complications, in spite of this therapy, can occur in up to 20% of the patients. Novel alternative therapies able to abrogate the aPL pathogenic action either by interfering with aPL binding at the placental level or by inhibiting the aPL-mediated detrimental effect are under active investigation.
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Mockova A, Dortova E, Dort J, Nahlovsky J, Korecko V, Ulcova-Gallova Z. Extremely hypotrophic newborn of mother with systemic lupus erythematosus and antiphospholipid syndrome. Lupus 2013; 23:313-8. [PMID: 24356613 DOI: 10.1177/0961203313517406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The case presented describes a high-risk pregnancy of a woman with systemic lupus erythematosus (SLE) with multiple lesions of central nervous system (CNS), vasculitis, secondary epilepsy and antiphospholipid syndrome (APS). At gestational age 28 weeks and 3 days the pregnancy was urgently terminated via caesarean section and an extremely hypotrophic immature newborn with a birth weight of 580 g was born. The high disease activity in the mother at the time of conception and the histologically proven chronic placental insufficiency due to APS are presumably the causes for the extensive hypotrophy of the neonate. The significant comorbidity of the newborn, including respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, osteopathy of prematurity, transient hypothyroidism and hypocortisolism, vesicoureteral reflux, and hypertonic-hyperexcitation syndrome complicated his three-month stay in NICU. A positive titre of transplacentally transferred anticardiolipin and anti-β2 glycoprotein antibody was detected in the child and persisted through the following 30 months. During the three-year follow-up, significantly delayed neuropsychological development with microcephaly (-4 SD) and short stature of the child was observed. Finally, the authors discuss possible causes of neuropsychological consequences in children of mothers with SLE and APS and emphasize the need for long-term monitoring and specialized care to improve development of these children.
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Affiliation(s)
- A Mockova
- 1Department of Neonatology, Faculty of Medicine in Pilsen and University Hospital, Charles University in Prague, Czech Republic
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24
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Abisror N, Mekinian A, Lachassinne E, Nicaise-Roland P, De Pontual L, Chollet-Martin S, Boddaert N, Carbillon L, Fain O. Autism spectrum disorders in babies born to mothers with antiphospholipid syndrome. Semin Arthritis Rheum 2013; 43:348-51. [DOI: 10.1016/j.semarthrit.2013.07.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 05/14/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022]
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25
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Mekinian A, Lachassinne E, Nicaise-Roland P, Carbillon L, Motta M, Vicaut E, Boinot C, Avcin T, Letoumelin P, De Carolis S, Rovere-Querini P, Lambert M, Derenne S, Pourrat O, Stirnemann J, Chollet-Martin S, Biasini-Rebaioli C, Rovelli R, Lojacono A, Ambrozic A, Botta A, Benbara A, Pierre F, Allegri F, Nuzzo M, Hatron PY, Tincani A, Fain O, Aurousseau MH, Boffa MC. European registry of babies born to mothers with antiphospholipid syndrome. Ann Rheum Dis 2012; 72:217-22. [PMID: 22589374 PMCID: PMC3551221 DOI: 10.1136/annrheumdis-2011-201167] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives This study aimed to describe the long-term outcome and immunological status of children born to mothers with antiphospholipid syndrome, to determine the factors responsible for childhood abnormalities, and to correlate the child's immunological profile with their mothers. Methods A prospective follow-up of a European multicentre cohort was conducted. The follow-up consisted of clinical examination, growth data, neurodevelopmental milestones and antiphospholipid antibodies (APL) screening. Children were examined at 3, 9, 24 months and 5 years. Results 134 children were analysed (female sex in 65 cases, birth weight 3000±500 g, height 48±3 cm). Sixteen per cent had a preterm birth (<37 weeks; n=22), and 14% weighted less than 2500 g at birth (n=19). Neonatal complications were noted in 18 cases (13%), with five infections (4%). During the 5-year follow-up, no thrombosis or systemic lupus erythematosus (SLE) was noted. Four children displayed behavioural abnormalities, which consisted of autism, hyperactive behaviour, feeding disorder with language delay and axial hypotony with psychomotor delay. At birth lupus anticoagulant was present in four (4%), anticardiolipin antibodies (ACL) IgG in 18 (16%), anti-β2 glycoprotein-I (anti-β2GPI) IgG/M in 16 (15%) and three (3%), respectively. ACL IgG and anti-β2GPI disappeared at 6 months in nine (17%) and nine (18%), whereas APL persisted in 10% of children. ACL and anti-β2GPI IgG were correlated with the same mother's antibodies before 6 months of age (p<0.05). Conclusion Despite the presence of APL in children, thrombosis or SLE were not observed. The presence of neurodevelopmental abnormalities seems to be more important in these children, and could justify long-term follow-up.
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Affiliation(s)
- Arsene Mekinian
- Service de Médecine Interne, Université Paris 13, AP-HP, Hôpital Jean Verdier, 93140 Bondy, France.
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26
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Pregnancy implications for systemic lupus erythematosus and the antiphospholipid syndrome. J Autoimmun 2012; 38:J197-208. [DOI: 10.1016/j.jaut.2011.11.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 11/22/2011] [Indexed: 01/01/2023]
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27
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Much more than thrombosis and pregnancy loss: The antiphospholipid syndrome as a ‘systemic disease’. Best Pract Res Clin Rheumatol 2012; 26:79-90. [DOI: 10.1016/j.berh.2012.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/04/2012] [Indexed: 11/19/2022]
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Bomba M, Nacinovich R, Oggiano S, Cassani M, Baushi L, Bertulli C, Longhi D, Coppini S, Parrinello G, Plebani A, Badolato R. Poor health-related quality of life and abnormal psychosocial adjustment in Italian children with perinatal HIV infection receiving highly active antiretroviral treatment. AIDS Care 2011; 22:858-65. [PMID: 20635250 DOI: 10.1080/09540120903483018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To evaluate health-related quality of life (HRQL), social competence, and behavioral problems in children with perinatal HIV infection receiving highly active antiretroviral therapy (HAART), a cross-sectional study was performed at the Department of Pediatrics, University of Brescia. We evaluated HRQL, social competence, and behavioral problems in 27 HIV-infected children compared with age and sex-matched control subjects using the Pediatric Quality of Life Inventory (PedsQL) and the Child Behavior Checklist (CBCL), respectively. On the PedsQL 4.0 Generic Core Scale, HIV-infected subjects displayed significantly reduced physical (p=0.043) and psychosocial health (p=0.021) functioning, particularly at school (p=0.000), compared with healthy subjects, resulting in a significantly reduced total score (p=0.013). Assessment of social competence and the behavioral features of HIV-infected children by means of the CBCL revealed severe limitations of functioning in HIV-infected children who had impaired social ability. Children with HIV-RNA above the threshold level of 50 had higher scores on the CBCL delinquent behavior (p=0.021) and school competence (p=0.025) subsets. Although the introduction of HAART regimens has prolonged the survival of HIV-infected children, other factors, including disease morbidity and familial and environmental conditions, negatively affect their quality of life, thereby contributing to increased risk for behavioral problems.
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Affiliation(s)
- Monica Bomba
- Cattedra di Neuropsichiatria dell'Infanzia e dell'Adolescenza, Universita di Brescia, Brescia, Italy
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29
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Abstract
Antiphospholipid antibodies (aPL) can be detected by functional (lupus anticoagulant) and/or by solid phase assays (anti-cardiolipin and anti-beta2 glycoprotein I). Although detectable in 1-5% of asymptomatic apparently healthy subjects, persistent aPL are significantly associated with recurrent arterial/venous thrombosis and with pregnancy morbidity. Such an association is the formal classification tool for the antiphospholipid syndrome (APS). The prevalence of the syndrome with no associated systemic connective tissue diseases (primary APS) in the general population is still a matter of debate since there are no sound epidemiological studies in the literature so far. aPL display higher prevalence in systemic lupus erythematosus and rheumatoid arthritis than in other systemic autoimmune diseases. However not all the aPL positive lupus patients display the clinical manifestations. Comparable findings may be found in the paediatric population, although anti-beta2 glycoprotein I antibodies are detected in healthy children more frequently than in adults. High prevalence of aPL has been also reported in clinical manifestations that are not formal APS classification criteria: heart valve disease, livedo reticular, nephropathy, neurological manifestations, and thrombocytopenia. Antiphospholipid antibodies can be associated with infectious processes, active vaccination, drug administration and malignancies. Their prevalence and titres are lower and the relationship with the APS clinical manifestations are less strong than in the previously mentioned conditions. Ethnicity was also reported to influence the prevalence of aPL.
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Affiliation(s)
- Martina Biggioggero
- Division of Rheumatology, Department of Internal Medicine-University of Milan, Istituto G. Pini, Italy
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30
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Boffa MC, Lachassinne E, Boinot C, De Carolis S, Rovere-Querini P, Avcin T, Biasini-Rebaioli C, Le Toumelin P, Aurousseau MH, Tincani A. European registry of babies born to mothers with antiphospholipid syndrome: a result update. Lupus 2009; 18:900-4. [PMID: 19671790 DOI: 10.1177/0961203309106951] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The registry is a prospective, European, multicentric, longitudinal study, which follows a cohort of children born to mothers with antiphospholipid syndrome (APS). It was started in 2003. In this report, we update the results obtained from the study of 110 mothers and 112 children (two twin births). Eighty per cent of the mothers (n = 86) had primary APS. Purely obstetrical, thrombotic and mixed (obstetrical and thrombotic) APS represent 65.5 %, 21.8 % and 12.7 % of the whole cohort respectively. Isolated antiphospholipid antibodies and isolated anticardiolipin antibodies positivity were present in 50 of 109 (46%) and in 34 of 109 (31%) of the pregnant women, respectively. In the babies, in spite of a high rate of prematurity (14.3%) with four (3.6%) of the premature babies born before 33 weeks of gestation and an increased number of newborns small for gestational age (17%), the large majority of the neonates were healthy. Thirty-one infants are now older than 24 months. Among them, three displayed behavioural abnormalities before 3 years of age. After completing data, there will be the possibility to evaluate the newborn status in relation to the mothers' diseases, treatments and antibodies and to follow the neuropsychological development and immunological evolution of the babies during the next 5 years.
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Affiliation(s)
- M-C Boffa
- Laboratoire d'Hématologie, Unité Hémostase et Thrombose, Bondy, France.
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31
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Motta M, Rodriguez-Perez C, Tincani A, Lojacono A, Nacinovich R, Chirico G. Neonates born from mothers with autoimmune disorders. Early Hum Dev 2009; 85:S67-70. [PMID: 19765919 DOI: 10.1016/j.earlhumdev.2009.08.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 07/29/2009] [Accepted: 07/29/2009] [Indexed: 11/26/2022]
Abstract
Systemic autoimmune disorders have a higher prevalence in women, particularly during their childbearing age. A growing interest is being paid to the possible consequences of maternal disease and associated treatment on the fetus and newborn infant. If maternal disease is characterized by the presence of IgG isotype auto-antibodies, these can cross the placenta with possible antibody-mediated damage to the fetus. The risk of gestational complications, including preterm delivery, intrauterine growth retardation and low birth weight is higher in autoimmune diseases rather than in the general population and probably this finding is related to both maternal disorder and immunosuppressive therapy. Recently, results of our studies suggest that the antenatal exposure to immunosuppressive drugs given to mothers during pregnancy to treat autoimmune diseases does not impair significantly the development of immunity in exposed children. Finally, mothers disease and/or treatment could be related to neuropsychological dysfunctions reported in some of their children.
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Affiliation(s)
- Mario Motta
- Neonatal Intensive Care Unit, Children's Hospital of Brescia, Brescia, Italy.
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Tincani A, Rebaioli CB, Andreoli L, Lojacono A, Motta M. Neonatal effects of maternal antiphospholipid syndrome. Curr Rheumatol Rep 2009; 11:70-6. [PMID: 19171114 DOI: 10.1007/s11926-009-0010-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Antiphospholipid antibodies (aPL) can impair the physiologic development of a fetus during pregnancy not only by causing thrombosis of the placental vessels, but also by directly binding throphoblast cells and modifying their functions. Consequently, the presence of aPL in pregnant women is linked to an increased rate of pregnancy complications. These include recurrent early miscarriages, late fetal losses, and hypertensive disorders of gestation. In this clinical setting, preeclampsia is usually early and severe and can be complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). The close association between aPL and obstetric pathology supports the inclusion of these manifestations in the clinical classification criteria of antiphospholipid syndrome. About 30% of children born to mothers with aPL passively acquire these autoantibodies; fortunately, the occurrence of thrombosis seems extremely rare in these babies. The prospective ongoing studies of children born to antiphospholipid syndrome patients reassure us about their general good health; however, some data suggest that learning difficulties might occur, possibly related to in utero exposure to aPL.
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Affiliation(s)
- Angela Tincani
- Reumatologia e Immunologia Clinica, Spedali Civili e Università di Brescia, Brescia, Italy.
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Rotar Ž, Rozman B, de Groot PG, Sanmarco M, Shoenfeld Y, Meroni PL, Cervera R, Pengo V, Cimaz R, Avčin T, Carp HJA, Tincani A. Sixth meeting of the European Forum on antiphospholipid antibodies. How to improve the understanding of the antiphospholipid syndrome? Lupus 2009; 18:53-60. [DOI: 10.1177/0961203308097569] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main objective of these meetings is to promote international collaboration in various clinical and research projects. This paper is the summary of the 2007 Ljubljana meeting, and offers an overview of the proposed projects. The technical and methodological details of the projects will be published on the forum’s web site (http://www.med.ub.es/MIMMUN/FORUM/STUDIES.HTM).
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Affiliation(s)
- Ž Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - B Rozman
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - PG de Groot
- Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Sanmarco
- Fédération Autoimmunité et Thrombose, Hôpital de la Conception, Marseille, France
| | - Y Shoenfeld
- Department of Medicine ‘B’ and Center for Autoimmune Diseases, The Sheba Medical Center, Research Unit of Autoimmune Diseases, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Tel Aviv, Israel
| | - PL Meroni
- Allergy, Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, University of Milan, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - R Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
| | - V Pengo
- Clinical Cardiology, Thrombosis Center, Department of Cardiac Thoracic and Vascular Sciences, University of Padova School of Medicine, Padova, Italy
| | - R Cimaz
- Paediatric Rheumatology, Meyer Children’s Hospital and University of Florence, Florence, Italy
| | - T Avčin
- Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - HJA Carp
- Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Tel-Aviv University, The Sackler Faculty of Medicine, Tel Aviv, Israel
| | - A Tincani
- Department of Rheumatology and Clinical Immunology, Brescia Hospital and University of Brescia, Brescia, Italy
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35
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Bibliography. Current world literature. Systemic lupus erythematosus and Sjögren's syndrome. Curr Opin Rheumatol 2008; 20:631-2. [PMID: 18698190 DOI: 10.1097/bor.0b013e3283110091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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