1
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Kumar P, Philip CE, Eskandar K, Marron K, Harrity C. Effect of intravenous immunoglobulin therapy in recurrent implantation failure: A Systematic review and meta-analysis. J Reprod Immunol 2024; 166:104323. [PMID: 39241575 DOI: 10.1016/j.jri.2024.104323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/11/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND IVIg is a pooled donor immunoglobulin preparation, used for auto-immune and inflammatory diseases. In assisted reproduction it receives considerable scepticism. Clinical data is expanding, but individual studies may be perceived as weak, meaning an updated appraisal of evidence in implantation failure is needed. OBJECTIVE To assess the efficacy of IVIg in Recurrent Implantation Failure (RIF) following assisted reproductive technology. DESIGN Systematic review and meta-analysis of randomized controlled trials and observational studies comparing IVIg therapy against placebo in a defined RIF population. MATERIALS AND METHODS A comprehensive literature search, identifying studies involving RIF following ART, using pre-conception IVIg. Primary outcomes were clinical pregnancy (CPR), live birth (LBR), implantation (IR), and miscarriage rates (MR). The selection process yielded twelve studies, including 1023 cases and 2276 controls. RESULTS A significant increase in CPR (OR=5.14, 95 % CI: 2.33-11.30, p<0.001) and LBR (OR=4.60, 95 % CI:2.44-8.68, p<0.001) is demonstrated in IVIG-treated patients, with an improvement in IR (OR=2.35, 95 % CI: 1.04-5.29, p=0.039) and reduction in MR (OR=0.60, 95 % CI: 0.37-0.97, p=0.036). Substantial heterogeneity was identified across studies, which was addressed through subgroup analyses, assessing if the variability in may be attributed to study-specific factors. CONCLUSIONS IVIg may enhance implantation, clinical pregnancy, and live birth rates in RIF patients, underscoring benefit for specific populations. Positive immunological risk factors may predict potential candidates, but it could also be of use in unexplained RIF with high-grade embryos. These findings highlight the importance of personalized therapeutic strategies to improve ART outcomes for complex cases.
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Affiliation(s)
| | - Chris E Philip
- Beaumont Hospital, Dublin, Ireland; Indiana University School of Medicine, Indianapolis, USA
| | | | | | - Conor Harrity
- Rotunda Hospital, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland; RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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2
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Kroopnick AJ, Miller EC. Approach to Altered Mental Status in Pregnancy and Postpartum. Semin Neurol 2024. [PMID: 39151911 DOI: 10.1055/s-0044-1788977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Abstract
The evaluation and diagnosis of altered mental status in the pregnant or postpartum patient largely parallels the approach used for any other patient; however, there are several critical differences including that some neuroobstetric diagnoses require emergent delivery of the fetus. Being familiar with the physiological changes and medical complications of pregnancy and delivery is therefore essential. This review first addresses pregnancy-specific disorders that may result in altered mental status, such as the hypertensive disorders of pregnancy and pregnancy-related metabolic and endocrinopathies. The focus then shifts to the complex physiologic changes in pregnancy and how these changes contribute to the distinct epidemiology of pregnancy-related cerebrovascular complications like intracranial hemorrhage, ischemic stroke, and reversible cerebral vasoconstriction syndrome. Medical disorders that are not unique to pregnancy, such as infections and autoimmune conditions, may present de novo or worsen during pregnancy and the peripartum period and require a thoughtful approach to diagnosis and management. Finally, the unique nervous system complications of obstetric anesthesia are explored. In each section, there is a focus not only on diagnosis and syndrome recognition but also on the emergent treatment needed to reverse these complications, bearing in mind the unique physiology of the pregnant patient.
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Affiliation(s)
- Adam J Kroopnick
- Department of Neurology, Columbia University, New York, New York
| | - Eliza C Miller
- Department of Neurology, Columbia University, New York, New York
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3
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Kwok A. Risk Assessment and Optimization for Pregnancy in Patients with Rheumatic Diseases. Diagnostics (Basel) 2024; 14:1414. [PMID: 39001304 PMCID: PMC11241172 DOI: 10.3390/diagnostics14131414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/13/2024] [Accepted: 06/16/2024] [Indexed: 07/16/2024] Open
Abstract
Patients with rheumatic diseases frequently operate with incomplete or incorrect information while planning for and experiencing pregnancy, often due to variability in provider care and knowledge. Risk assessment at each stage of pregnancy-pre-conception, during pregnancy, and postpartum-is focused on reducing maternal and neonatal complications. This review aims to compile updated, evidence-based guidance on how to minimize risk factors contributing to adverse pregnancy outcomes (APOs). Mitigation of known causes of infertility, appropriate testing and monitoring, achieving low disease activity on pregnancy-safe disease-modifying antirheumatic drugs (DMARDs) prior to conception, controlling hypertension (a frequent comorbidity among patients with certain rheumatic diseases), and the use of appropriate adjunctive medications (such as low-dose aspirin when preeclampsia risk is high) can optimize fertility and prevent adverse maternal and neonatal outcomes.
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Affiliation(s)
- Alyssa Kwok
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, 1601 Trinity St., Austin, TX 78712, USA
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4
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Carpenter MC, Souter SC, Zipkin RJ, Ackerman ME. Current Insights Into K-associated Fetal Anemia and Potential Treatment Strategies for Sensitized Pregnancies. Transfus Med Rev 2024; 38:150779. [PMID: 37926651 PMCID: PMC10856777 DOI: 10.1016/j.tmrv.2023.150779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023]
Abstract
K-associated anemic disease of the fetus and newborn (K-ADFN) is a rare but life-threatening disease in which maternal alloantibodies cross the placenta and can mediate an immune attack on fetal red blood cells expressing the K antigen. A considerably more common disease, D-associated hemolytic disease of the fetus and newborn (D-HDFN), can be prophylactically treated using polyclonal α-D antibody preparations. Currently, no such prophylactic treatment exists for K-associated fetal anemia, and disease is usually treated with intrauterine blood transfusions. Here we review current understanding of the biology of K-associated fetal anemia, how the maternal immune system is sensitized to fetal red blood cells, and what is understood about potential mechanisms of prophylactic HDFN interventions. Given the apparent challenges associated with preventing alloimmunization, we highlight novel strategies for treating sensitized mothers to prevent fetal anemia that may hold promise not only for K-mediated disease, but also for other pathogenic alloantibody responses.
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Affiliation(s)
| | | | | | - Margaret E Ackerman
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA; Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
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5
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Rieneck K, Rasmussen KK, Schoof EM, Clausen FB, Holze H, Bergholt T, Jørgensen MH, Christensen VB, Almaas R, Jordal PL, Locard-Paulet M, Runager K, Nielsen LK, Schlotmann BC, Weischenfeldt JL, Jensen LJ, Dziegiel MH. Hunting for the elusive target antigen in gestational alloimmune liver disease (GALD). PLoS One 2023; 18:e0286432. [PMID: 37862305 PMCID: PMC10588877 DOI: 10.1371/journal.pone.0286432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/16/2023] [Indexed: 10/22/2023] Open
Abstract
The prevailing concept is that gestational alloimmune liver disease (GALD) is caused by maternal antibodies targeting a currently unknown antigen on the liver of the fetus. This leads to deposition of complement on the fetal hepatocytes and death of the fetal hepatocytes and extensive liver injury. In many cases, the newborn dies. In subsequent pregnancies early treatment of the woman with intravenous immunoglobulin can be instituted, and the prognosis for the fetus will be excellent. Without treatment the prognosis can be severe. Crucial improvements of diagnosis require identification of the target antigen. For this identification, this work was based on two hypotheses: 1. The GALD antigen is exclusively expressed in the fetal liver during normal fetal life in all pregnancies; 2. The GALD antigen is an alloantigen expressed in the fetal liver with the woman being homozygous for the minor allele and the father being, most frequently, homozygous for the major allele. We used three different experimental approaches to identify the liver target antigen of maternal antibodies from women who had given birth to a baby with the clinical GALD diagnosis: 1. Immunoprecipitation of antigens from either a human liver cell line or human fetal livers by immunoprecipitation with maternal antibodies followed by mass spectrometry analysis of captured antigens; 2. Construction of a cDNA expression library from human fetal liver mRNA and screening about 1.3 million recombinants in Escherichia coli using antibodies from mothers of babies diagnosed with GALD; 3. Exome/genome sequencing of DNA from 26 presumably unrelated women who had previously given birth to a child with GALD with husband controls and supplementary HLA typing. In conclusion, using the three experimental approaches we did not identify the GALD target antigen and the exome/genome sequencing results did not support the hypothesis that the GALD antigen is an alloantigen, but the results do not yield basis for excluding that the antigen is exclusively expressed during fetal life., which is the hypothesis we favor.
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Affiliation(s)
- Klaus Rieneck
- Laboratory of Blood Genetics, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
| | - Karen Koefoed Rasmussen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Erwin M. Schoof
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Frederik Banch Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
| | - Henrietta Holze
- Novo Nordisk Foundation Center for Protein Research, Copenhagen, Denmark
| | - Thomas Bergholt
- Department of Obstetrics and Gynecology, Herlev Hospital, Herlev, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Runar Almaas
- Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | - Leif Kofoed Nielsen
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | | | | | - Lars Juhl Jensen
- Novo Nordisk Foundation Center for Protein Research, Copenhagen, Denmark
| | - Morten Hanefeld Dziegiel
- Laboratory of Blood Genetics, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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6
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Swonger RM, Syros A, Finch L, Moore J, Lauture A, Soto Rincon A, Tinker N, Zbeidy R, Ghulmiyyah L, Paidas M. Guillain-Barre Syndrome With Concomitant Severe Preeclampsia: A Case Report. Cureus 2023; 15:e40796. [PMID: 37485223 PMCID: PMC10362806 DOI: 10.7759/cureus.40796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
With an estimated 100,000 new cases yearly worldwide, Guillain-Barre syndrome (GBS) is the most common cause of flaccid paralysis. GBS is exceedingly rare in pregnancy and carries high maternal and fetal risk. We report a case of a 38-year-old essential primigravida who presented at 38 weeks six days gestational age with ascending paraplegia progressing to dysarthria, dysphagia, and facial weakness. A clinical diagnosis of GBS was made in an outside institution, supported by elevated protein on lumbar puncture. During the antepartum period, a diagnosis of gestational hypertension progressed to preeclampsia with severe features when a sudden rise in liver function tests occurred. The patient underwent an uneventful planned cesarean delivery but could not be extubated due to respiratory failure. After a 20-day critical care admission, she was extubated and had an improvement in neurologic status to near her baseline.
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Affiliation(s)
| | - Alina Syros
- Miller School of Medicine, University of Miami, Miami, USA
| | - Lindsey Finch
- Obstetrics and Gynecology, University of Miami/Jackson Memorial Hospital, Miami, USA
| | - Jessica Moore
- Obstetrics and Gynecology, University of Miami/Jackson Memorial Hospital, Miami, USA
| | | | - Alvaro Soto Rincon
- Anesthesiology, University of Miami/Jackson Memorial Hospital, Miami, USA
| | - Nicholas Tinker
- Obstetrics and Gynecology, University of Miami/Jackson Memorial Hospital, Miami, USA
| | - Reine Zbeidy
- Anesthesiology and Perioperative Medicine, University of Miami/Jackson Memorial Hospital, Miami, USA
| | - Labib Ghulmiyyah
- Obstetrics and Gynaecology, University of Miami/Jackson Memorial Hospital, Miami, USA
| | - Michael Paidas
- Obstetrics and Gynecology, University of Miami/Jackson Memorial Hospital, Miami, USA
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7
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Zhang S, Cunningham-Rundles C. Primary Antibody Immunodeficiency and the Pregnant Patient. Immunol Allergy Clin North Am 2023; 43:133-144. [PMID: 36410999 DOI: 10.1016/j.iac.2022.07.009] [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: 11/05/2022]
Abstract
An overview of primary antibody immunodeficiency in pregnancy is presented. Indications for immunoglobulin replacement therapy (IGRT), dosing, and safety considerations are highlighted. Uses of immunizations and antimicrobial therapy are also discussed. In general, IGRT, both intravenous and subcutaneous, is considered safe in pregnancy.
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Affiliation(s)
- Shouling Zhang
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Menascu S, Siegel-Kirshenbaum M, Dreyer-Alster S, Warszawer Y, Magalashvili D, Dolev M, Mandel M, Harari G, Achiron A. Intravenous immunoglobulin treatment during pregnancy and the post-partum period in women with multiple sclerosis: A prospective analysis. Mult Scler J Exp Transl Clin 2023; 9:20552173221151127. [PMID: 36687367 PMCID: PMC9853871 DOI: 10.1177/20552173221151127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
Background Relapsing-remitting multiple sclerosis (RRMS) affects predominantly young women within reproductive years. As an increased risk of relapses is known to occur during the post-partum period, it is important to consider treatment options. Aim Evaluate the effects of intravenous immunoglobulins (IVIg) to prevent post-partum relapses. Methods We prospectively followed 198 pregnant female RRMS patients, 67 treated with IVIg during pregnancy and the three months post-partum, and 131 untreated patients that served as controls. Results During the pre-gestation year, 41.4% were treated with immunomodulatory drugs, and 28.3% experienced a relapse. During pregnancy and the post-partum period, the number of relapsing patients significantly decreased in the IVIg group (37.3%, 10.4%, 8.9%, respectively, p = 0.0003), while no significant change was observed in the untreated group (23.7%, 17.6%, and 22.1%). During the three-month post-partum period, there were only mild and moderate relapses in the IVIg group, while in the untreated group, there were also severe relapses. Stepwise logistic regression that assessed the relation between three-month post-partum relapse and explanatory variables demonstrated that untreated patients had increased risk for post-partum relapse (odds ratio = 4.6, 95% CI [1.69, 12.78], p = 0.033). Conclusions IVIg treatment proved efficient to reduce the rate and severity of relapses during pregnancy and the three-month post-partum.
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Affiliation(s)
- Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Ramat-Gann, Israel,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Siegel-Kirshenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel,Fertility Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gann, Israel
| | | | - Yehuda Warszawer
- Multiple Sclerosis Center, Sheba Medical Center, Ramat-Gann, Israel
| | | | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Ramat-Gann, Israel
| | - Mathilda Mandel
- Multiple Sclerosis Center, Sheba Medical Center, Ramat-Gann, Israel
| | - Gil Harari
- Multiple Sclerosis Center, Sheba Medical Center, Ramat-Gann, Israel
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Ramat-Gann, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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9
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Choi H, Yang SW, Joo JS, Park M, Jin Y, Kim JW, Lee SY, Lee SV, Yun TJ, Cho ML, Hwang HS, Kang YS. Sialylated IVIg binding to DC-SIGN + Hofbauer cells induces immune tolerance through the caveolin-1/NF-kB pathway and IL-10 secretion. Clin Immunol 2023; 246:109215. [PMID: 36581222 DOI: 10.1016/j.clim.2022.109215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/15/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
Although the use of IVIg has increased in various immune-driven diseases and even in pregnancy, the exact action mechanisms of IVIg are not fully understood. Dendritic cell-specific intercellular adhesion molecule-3 grabbing non-integrin (DC-SIGN) is a known receptor for α-2,6-sialylated IgG (sIVIg), which is responsible for the anti-inflammatory effect of IVIg. DC-SIGN is expressed on Hofbauer cells (HBCs) of the fetal villi of the placenta which act as an innate immune modulator at the maternal-fetal interface. Preeclampsia is a major complication in pregnancy and is related to IL-10, a cytokine with an important role in immune tolerance. DC-SIGN interaction with sIVIg in HBCs promoted IL-10 secretion through the activation of the caveolin-1/NF-κB pathway, especially in plasma lipid rafts. Consistent results were obtained for HBCs from patients with preeclampsia. Collectively, the stimulation of DC-SIGN+ HBCs with sIVIg enhanced immune tolerance in the feto-maternal environment, suggesting the therapeutic application of sIVIg to prevent preeclampsia.
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Affiliation(s)
- Hyeongjwa Choi
- Department of KONKUK-KIST Biomedical Science & Technology, Konkuk University; 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Seung-Woo Yang
- Department of Obstetrics and Gynecology, Sang-Gye Paik Hospital, Inje University School of Medicine; Seoul 01757, Republic of Korea
| | - Jin-Soo Joo
- Department of KONKUK-KIST Biomedical Science & Technology, Konkuk University; 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea; Department of Veterinary Pharmacology and Toxicology, Veterinary Science Research Institute, College of Veterinary Medicine, Konkuk University; 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Min Park
- Department of KONKUK-KIST Biomedical Science & Technology, Konkuk University; 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Yihua Jin
- Department of KONKUK-KIST Biomedical Science & Technology, Konkuk University; 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Ji-Woon Kim
- Department of KONKUK-KIST Biomedical Science & Technology, Konkuk University; 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Seon-Yeong Lee
- The Rheumatism Research Center, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Vin Lee
- Department of Veterinary Pharmacology and Toxicology, Veterinary Science Research Institute, College of Veterinary Medicine, Konkuk University; 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Tae-Jin Yun
- Department of Pathology, New York University Grossman School of Medicine; New York, NY 10016, USA
| | - Mi-La Cho
- The Rheumatism Research Center, The Catholic University of Korea, Seoul, South Korea; Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, South Korea
| | - Han-Sung Hwang
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine; Seoul, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea.
| | - Young-Sun Kang
- Department of KONKUK-KIST Biomedical Science & Technology, Konkuk University; 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea; Department of Veterinary Pharmacology and Toxicology, Veterinary Science Research Institute, College of Veterinary Medicine, Konkuk University; 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea; KU Research Center for Zoonosis, Konkuk University; 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea.
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10
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De Vos TW, De Haas M, Oepkes D, Tan RRNGB, Van der Schoot CE, Steggerda SJ, de Vries LS, Lopriore E, Van Klink JMM. Long-term neurodevelopmental outcome in children after antenatal intravenous immune globulin treatment in fetal and neonatal alloimmune thrombocytopenia. Am J Obstet Gynecol 2022; 227:637.e1-637.e9. [PMID: 35671780 DOI: 10.1016/j.ajog.2022.05.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/17/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with fetal and neonatal alloimmune thrombocytopenia (FNAIT) face increased risk of intracranial hemorrhage (ICH) potentially leading to developmental impairment. To prevent ICH, pregnant women with alloantibodies against fetal platelets are often treated with intravenous immunoglobulin (IVIg). IVIg appears effective in vastly reducing the risk of fetal or neonatal bleeding complications. However, information on long-term neurodevelopment of these children is lacking. OBJECTIVE To evaluate long-term neurodevelopmental outcome in children with FNAIT who were treated with IVIg antenatally. STUDY DESIGN An observational cohort study was performed including children of mothers who were treated with IVIg during pregnancy because a previous child was diagnosed with FNAIT. Children, were invited for a follow-up assessment including standardized cognitive and neurologic tests. The parents were asked to complete a behavioral questionnaire and school performance reports. The primary outcome was severe neurodevelopmental impairment (NDI), defined as severe cognitive impairment (IQ < 70), cerebral palsy with Gross Motor Function Classification System (GMFCS) Level ≥ 3, bilateral blindness, and/or bilateral deafness (requiring amplification). The secondary outcome was mild to moderate NDI, defined as either mild to moderate cognitive impairment (IQ < 85), cerebral palsy with GMFCS Level ≤ 2, minor neurologic dysfunction, vision loss, and/or hearing loss. RESULTS Between 2003 and 2017, 51 children were liveborn after antenatal IVIg treatment. One family moved abroad and was therefore not eligible for inclusion. In total, 82% (41/50) of the eligible cases were included for neurodevelopmental assessment at a median age of 9 years and 8 months. Severe NDI was not detected. The incidence of mild to moderate NDI was 14% (6/41, 95% confidence interval: 6%-29%). The children's mean cognitive score, behavioral scores, and academic achievement were not different from the Dutch norm groups. Neuroimaging was performed in 90% (37/41) of cases. Severe ICH had been diagnosed in two cases (5%), one antenatally before the start of IVIg and the other case 1 day after birth. Both cases had a normal neurodevelopmental outcome. CONCLUSION The risk of NDI in children whose mothers were treated for FNAIT with antenatal IVIg is comparable to that in the general population.
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Affiliation(s)
- Thijs W De Vos
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands; Center of Clinical Transfusion Research, Sanquin Research, Amsterdam; Department of Experimental Immunohematology, Sanquin Research, Amsterdam.
| | - Masja De Haas
- Center of Clinical Transfusion Research, Sanquin Research, Amsterdam; Department Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam; Department of Hematology, Leiden University Medical Center, Leiden
| | - Dick Oepkes
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden
| | - Ratna R N G B Tan
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | | | - Sylke J Steggerda
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Linda S de Vries
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Enrico Lopriore
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Jeanine M M Van Klink
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Child and Adolescent Psychology, Leiden University Medical Center, the Netherlands
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11
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Gerbier E, Graber SM, Rauch M, Marxer CA, Meier CR, Baud D, Winterfeld U, Blozik E, Surbek D, Spoendlin J, Panchaud A. Use of Prescribed Drugs to Treat Chronic Diseases during Pregnancy in Outpatient Care in Switzerland between 2014 and 2018: Descriptive Analysis of Swiss Health Care Claims Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1456. [PMID: 35162474 PMCID: PMC8835338 DOI: 10.3390/ijerph19031456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 02/06/2023]
Abstract
Evidence on the use of drugs during pregnancy in Switzerland is lacking. We aimed to evaluate the utilisation of drugs to treat chronic diseases during pregnancy in Switzerland. We identified all pregnancies (excluding abortions) in Swiss Helsana claims data (2014-2018). In those, we identified all claims for drugs to treat a chronic disease, which typically affects women of childbearing age. Potentially teratogenic/fetotoxic drugs were evaluated during specific risk periods. Results were demographically weighted relative to the Swiss population. We identified claims for ≥1 drug of interest during 22% of 369,371 weighted pregnancies. Levothyroxine was most frequently claimed (6.6%). Antihypertensives were claimed during 5.3% (3.9% nifedipine in T3). Renin-Angiotensin-Aldosterone System (RAAS) inhibitors were dispensed to 0.3/10,000 pregnancies during trimester 2 (T2) or trimester 3 (T3). Insulin was claimed during 3.5% of pregnancies, most frequently in T3 (3.3%). Exposure to psychotropic drugs was 3.8% (mostly Selective serotonin reuptake inhibitors (SSRIs)) and to drugs for obstructive airway diseases 3.6%. Traditional immunosuppressants (excluding corticosteroids) were claimed during 0.5% (mainly azathioprine and hydroxychloroquine), biologic immunosuppressants (Tumour necrosis factor-alpha (TNF-alpha) inhibitors and interleukin inhibitors) during 0.2%, and drugs to treat multiple sclerosis during 0.09% of pregnancies. Antiretrovirals were claimed during 0.15% of pregnancies. Patterns of drug claims were in line with treatment recommendations, but relatively rare events of in utero exposure to teratogenic drugs may have had severe implications for those involved.
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Affiliation(s)
- Eva Gerbier
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Sereina M. Graber
- Department of Health Sciences, Helsana Insurance Group, 8001 Zurich, Switzerland; (S.M.G.); (E.B.)
| | - Marlene Rauch
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, 4031 Basel, Switzerland; (M.R.); (C.A.M.); (C.R.M.); (J.S.)
- Hospital Pharmacy, University Hospital Basel, 4056 Basel, Switzerland
| | - Carole A. Marxer
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, 4031 Basel, Switzerland; (M.R.); (C.A.M.); (C.R.M.); (J.S.)
- Hospital Pharmacy, University Hospital Basel, 4056 Basel, Switzerland
| | - Christoph R. Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, 4031 Basel, Switzerland; (M.R.); (C.A.M.); (C.R.M.); (J.S.)
- Hospital Pharmacy, University Hospital Basel, 4056 Basel, Switzerland
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department “Woman-Mother-Child”, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Ursula Winterfeld
- Swiss Teratogen Information Service and Clinical Pharmacology Service, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Eva Blozik
- Department of Health Sciences, Helsana Insurance Group, 8001 Zurich, Switzerland; (S.M.G.); (E.B.)
- Institute of Primary Care, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynaecology, Bern University Hospital, Insel Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Julia Spoendlin
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, 4031 Basel, Switzerland; (M.R.); (C.A.M.); (C.R.M.); (J.S.)
- Hospital Pharmacy, University Hospital Basel, 4056 Basel, Switzerland
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
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