Fetal outcome in anti-NMDAR encephalitis during pregnancy: a case report

Scorrano, Giovanna; Evangelista, Giacomo; Chiarelli, Francesco; Anzellotti, Francesca

doi:10.1007/s13760-022-02020-0

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…Pre-term delivery can also be planned to reduce fetal antibody exposure and improve maternal and fetal outcomes ( 98 ). Isolated cases with respiratory distress, neural tube closing defects, and reduced body weight have been described, possibly correlated with the administration of antiepileptic and sedative treatments ( 79 , 100 ). Among cases with poor fetal outcomes, a symptomatic woman who developed an anti-NMDAR encephalitis relapse in the context of a new ovarian teratoma at 37-week's gestation with a fatal fetal outcome has been described.…”

Section: Autoimmune Encephalitismentioning

confidence: 99%

Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know?

et al. 2022

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Antibody-mediated central nervous system (CNS) disorders including those associated with aquaporin-4 or myelin oligodendrocyte glycoprotein IgG and autoimmune encephalitis often affect women of childbearing age. Pathogenic antibodies of these diseases can potentially alter reproductive functions and influence fetal development. Hormonal changes occurring during pregnancy may modify the course of autoimmune diseases by influencing relapse risk, attack severity, and affect the delivery and postpartum period. Moreover, balancing treatment related safety issues with the risk of potentially disabling relapses during pregnancy and breastfeeding are major challenges. Intentional prenatal, gestational, and post-partum counseling is paramount to address these issues and mitigate these risks. Fortunately, new insights on risk factors for adverse pregnancy outcomes and possible preventive strategies are emerging. This review aims to summarize the interplay between antibody-mediated CNS disorders and pregnancy during the prenatal, gestational, and postpartum periods, highlight current treatment recommendations, and discuss future areas of research.

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Section: Autoimmune Encephalitismentioning

confidence: 99%

Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know?

et al. 2022

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Perinatal outcome in anti-NMDAr encephalitis during pregnancy—a systematic review with individual patients’ data analysis

Scorrano,

Dono,

Corniello

et al. 2024

Neurol Sci

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Introduction Anti-N-methyl-D-aspartate receptor (NMDAr) antibody encephalitis is an autoimmune disorder characterized by synaptic NMDAr current disruption and receptor hypofunction, often affecting women during pregnancy. Clinical manifestations associated with anti-NMDAr encephalitis can occur both in the mother and fetus. Methods We generated a systematic search of the literature to identify epidemiological, clinical, and serological data related to pregnant women with anti-NMDAr encephalitis and their children, analyzing the fetal outcomes. We examined the age and neurologic symptoms of the mothers, the presence of an underlying tumor, immunotherapies used during pregnancy, duration of the pregnancy, and type of delivery. Results Data from 41 patients were extrapolated from the included studies. Spontaneous interruption of pregnancy, premature birth, and cesarean section were reported in pregnant women with NMDAr encephalitis. Several fetal and neonatal symptoms (e.g., movement disorders, spina bifida, poor sucking, respiratory distress, cardiac arrhythmias, infections, icterus, hypoglycemia, and low birth weight) depending on the mother’s serum anti-NR1 concentration were also reported. Conclusions We characterized the outcomes of children born from mothers with anti-NMDAr encephalitis, analyzing the pivotal risk factors related to pregnancy and maternal disorder. Neuropsychiatric involvement seems strictly related to pathogenic NMDAr antibodies detected in maternal and/or neonatal serum. These findings clarify a complex condition to manage, outlining the risks associated with pregnant women with anti-NMDAr encephalitis and also providing a concrete guide for therapeutic strategies to prevent potential harm to the fetus and the child’s neurodevelopment.

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The Management and Diagnosis of Anti-NMDA Receptor Autoimmune Encephalitis in Pregnant Women: A Case Report and Literature Review

Potorac,

Varlas,

Borș

et al. 2023

Medicina

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Rationale: Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a form of autoimmune synaptic encephalitis, often mediated by neuronal surface antibodies. Clinically, it manifests through a diverse range of neurological and psychiatric symptoms, primarily affecting young women with ovarian teratoma, which is rare in pregnant women. Patient concerns: We report a case of a 35-year-old multiparous pregnant patient at 38 weeks of gestation presented to the emergency room with seizure, psychiatric symptoms like delirious speech with mystical visual and auditory hallucinations, bradylalia, and retrograde amnesia. Diagnosis: The diagnosis of autoimmune encephalitis with anti-NMDA antibodies was concluded by considering the lumbar puncture results, brain imaging, and the patient’s persistent symptoms. Outcomes: This case is noteworthy for its rarity and the symptoms’ breadth. At 38 weeks of gestation, the patient underwent a cesarean section, resulting in excellent maternal recovery observed during the 6-month follow-up and good neonatal adaptation. Lessons: Our goals include raising awareness about this condition and emphasizing the significance of early diagnosis. This encephalitis is treatable and potentially reversible, underscoring the importance of prompt identification.

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Fetal outcome in anti-NMDAR encephalitis during pregnancy: a case report

Cited by 3 publications

References 5 publications

Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know?

Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know?

Perinatal outcome in anti-NMDAr encephalitis during pregnancy—a systematic review with individual patients’ data analysis

The Management and Diagnosis of Anti-NMDA Receptor Autoimmune Encephalitis in Pregnant Women: A Case Report and Literature Review

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