“APS pregnancy – The offspring”

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.

Neonatal IVC thrombosis in a baby born to an aPL positive mother – a case report

“…A study in healthy children with no transplacental transfer of pathogenic antibodies found that 48% showed positivity for anti-b2G1 IgG antibodies which peaked at 6 months of age and then progressively decreased. 8 Although similar associations were not found for the other aPLs tested, this highlights an interesting potential pathway for the synthesis of de novo aPLs in neonates and foetuses.…”

“…Inflammation in the period before birth has been found to affect the pool of peripheral regulatory T cells in the cord blood of premature infants, thereby potentially affecting the development and function of the innate and adaptive immune systems. 8 In these premature infants, the immune system effects and newly-synthesised aPLs may act as the two ‘hits’. In the present case, the mother had gestational hypertension, which may have acted as a risk factor for foetal thrombosis.…”

Symptomatic aortic thrombosis in a preterm neonate

“…In our case, the baby was born growth-restricted, which is also incriminated in the causation of thrombosis by some authors, especially in babies with underlying prothrombotic conditions 7. Another important aspect is the maternal presence of autoantibodies like antiphospholipid antibodies, which can also predispose neonates to thrombosis, suggesting a need to screen such babies for the same in the neonatal period 8…”