European registry of babies born to mothers with antiphospholipid syndrome

Arsene Mekinian, Eric Lachassinne, Pascale Nicaise-Roland, Lionel Carbillon, Mario Motta, Eric Vicaut, Catherine Boinot, Tadej Avcin, Philippe Letoumelin, Sara De Carolis, Patrizia Rovere-Querini, Marc Lambert, Sophie Derenne, Olivier Pourrat, Jerome Stirnemann, Sylvie Chollet-Martin, Chiara Biasini-Rebaioli, Rosanna Rovelli, Andrea Lojacono, Ales Ambrozic, Angela Botta, Amelie Benbara, Fabrice Pierre, Flavio Allegri, Monica Nuzzo, Pierre-Yves Hatron, Angela Tincani, Olivier Fain, Marie-Helene Aurousseau, Marie-Claire Boffa, Arsene Mekinian, Eric Lachassinne, Pascale Nicaise-Roland, Lionel Carbillon, Mario Motta, Eric Vicaut, Catherine Boinot, Tadej Avcin, Philippe Letoumelin, Sara De Carolis, Patrizia Rovere-Querini, Marc Lambert, Sophie Derenne, Olivier Pourrat, Jerome Stirnemann, Sylvie Chollet-Martin, Chiara Biasini-Rebaioli, Rosanna Rovelli, Andrea Lojacono, Ales Ambrozic, Angela Botta, Amelie Benbara, Fabrice Pierre, Flavio Allegri, Monica Nuzzo, Pierre-Yves Hatron, Angela Tincani, Olivier Fain, Marie-Helene Aurousseau, Marie-Claire Boffa

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-β(2) 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.

Conflict of interest statement

Competing interests: None.

References

    1. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4:295–306
    1. Wilson WA, Gharavi AE, Koike T, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 1999;42:1309–11
    1. Boffa MC, Lachassinne E. Infant perinatal thrombosis and antiphospholipid antibodies: a review. Lupus 2007;16:634–41
    1. Motta M, Chirico G, Rebaioli CB, et al. Anticardiolipin and anti-beta2 glycoprotein I antibodies in infants born to mothers with antiphospholipid antibody-positive autoimmune disease: a follow-up study. Am J Perinatol 2006;23:247–51
    1. Ross G, Sammaritano L, Nass R, et al. Effects of mothers' autoimmune disease during pregnancy on learning disabilities and hand preference in their children. Arch Pediatr Adolesc Med 2003;157:397–402
    1. Neri F, Chimini L, Bonomi F, et al. Neuropsychological development of children born to patients with systemic lupus erythematosus. Lupus 2004;13:805–11
    1. Brewster JA, Shaw NJ, Farquharson RG. Neonatal and pediatric outcome of infants born to mothers with antiphospholipid syndrome. J Perinat Med 1999;27:183–7
    1. Nacinovich R, Galli J, Bomba M, et al. Neuropsychological development of children born to patients with antiphospholipid syndrome. Arthritis Rheum 2008;59:345–51
    1. Boffa MC, Aurousseau MH, Lachassinne E, et al. European register of babies born to mothers with antiphospholipid syndrome. Lupus 2004;13:713–17
    1. Levy SE, Mandell DS, Schultz RT. Autism. Lancet 2009;374:1627–38
    1. Ruffatti A, Tonello M, Cavazzana A, et al. Laboratory classification categories and pregnancy outcome in patients with primary antiphospholipid syndrome prescribed antithrombotic therapy. Thromb Res 2009;123:482–7
    1. Shrot S, Katzav A, Korczyn AD, et al. Behavioral and cognitive deficits occur only after prolonged exposure of mice to antiphospholipid antibodies. Lupus 2002;11:736–43
    1. Caronti B, Calderaro C, Alessandri C, et al. Serum anti-beta2-glycoprotein I antibodies from patients with antiphospholipid antibody syndrome bind central nervous system cells. J Autoimmun 1998;11:425–9
    1. Keil A, Daniels JL, Forssen U, et al. Parental autoimmune diseases associated with autism spectrum disorders in offspring. Epidemiology 2010;21:805–8
    1. Pinto-Martin JA, Levy SE, Feldman JF, et al. Prevalence of autism spectrum disorder in adolescents born weighing <2000 grams. Pediatrics 2011;128:883–91
    1. Zurgil N, Bakimer R, Tincani A, et al. Detection of anti-phospholipid and anti-DNA antibodies and their idiotypes in newborns of mothers with anti-phospholipid syndrome and SLE. Lupus 1993;2:233–7
    1. Nicaise-Roland P, Aurousseau MH, Delaval A, et al. Levels of anticardiolipin and anti-beta(2)-glycoprotein I antibodies in healthy newborn cord sera. Thromb Haemost 2008;99:1–3
    1. Avcin T, Ambrozic A, Kuhar M, et al. Anticardiolipin and anti-beta(2) glycoprotein I antibodies in sera of 61 apparently healthy children at regular preventive visits. Rheumatology (Oxford) 2001;40:565–73
    1. Andreoli L, Nalli C, Motta M, et al. Anti-β2-glycoprotein I IgG antibodies from 1-year-old healthy children born to mothers with systemic autoimmune diseases preferentially target domain 4/5: might it be the reason for their ‘innocent’ profile? Ann Rheum Dis 2011;70:380–3

Source: PubMed

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