Maternal-Fetal Transfer of Anti–N-Methyl-D-Aspartate Receptor Antibodies

Lamale‐Smith, Leah; Moore, Gaea S.; Guntupalli, Saketh R.; Scott, Julie

doi:10.1097/aog.0000000000000548

Cited by 28 publications

(20 citation statements)

References 12 publications

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“…A previous report exists of a newborn that was positive for NMDA receptor antibodies . This report suggests that maternal antibodies can pass via fetal circulation.…”

Section: Discussionmentioning

confidence: 68%

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Anti‐N‐methyl‐d‐aspartate receptor encephalitis during pregnancy: A case report

Keskin

Tanburoğlu

İdıman

et al. 2019

J of Obstet and Gynaecol

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Following a generalized tonic–clonic seizure, a previously healthy 27‐year‐old pregnant woman (18‐week pregnancy) was admitted to our emergency department. She experienced lethargy, forgetfulness and persecutory hallucinations the day before hospitalization. Cerebrospinal fluid examination revealed moderate pleocytosis, and abdominal ultrasonography did not detect neoplasia. Orofacial dyskinesia, catatonia and central hypoventilation gradually developed despite medical intervention to ameliorate the symptoms. At 32 weeks of pregnancy, vaginal bleeding and hypotension occurred. Further, owing to septic shock due to fetal demise, the patient died. N‐methyl‐d‐aspartate antibody test results obtained after the patient's death were positive (2++). Currently, no consensus exists on the appropriate treatment and follow‐up for pregnant women with anti‐N‐methyl‐d‐aspartate receptor encephalitis; however, immunomodulators and teratoma resection may be helpful. Second line immunotherapy (rituximab, cyclophosphamide) and teratoma resection may be necessary in pregnant patients with high N‐methyl‐d‐aspartate receptor antibody titers and inadequate response to first‐line treatment.

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“…A previous report exists of a newborn that was positive for NMDA receptor antibodies . This report suggests that maternal antibodies can pass via fetal circulation.…”

Section: Discussionmentioning

confidence: 68%

“…A previous report exists of a newborn that was positive for NMDA receptor antibodies. 11 This report suggests that maternal antibodies can pass via fetal circulation. The NMDA receptors have an important role in the brain development and glutamatergic dysfunction plays an important role in the genesis of schizophrenia.…”

Section: Discussionmentioning

confidence: 86%

Anti‐N‐methyl‐d‐aspartate receptor encephalitis during pregnancy: A case report

Keskin

Tanburoğlu

İdıman

et al. 2019

J of Obstet and Gynaecol

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“…Pathological examination of tissue sections positive for anti‐NMDA‐R encephalitis highlight the role of teratomas in this disease. According to the case series to date, four of the 12 cases had ovarian teratoma, and the tumors were always explored by MRI 3 weeks to 4 months after the appearance of neurological symptoms (Table ) . Negative results are related to barrier of the gravid uterus, short follow‐up time, or poor auxiliary examination.…”

Section: Discussionmentioning

confidence: 99%

Anti‐NMDA‐receptor encephalitis during pregnancy: A case report and literature review

Xiao

Gui

Bai

et al. 2017

J of Obstet and Gynaecol

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Anti-N-methyl-d-aspartate receptor (anti-NMDA-R) encephalitis is an autoimmune disorder that was first described by Dr Vitaliani in 2005. In 2007, Dalmau et al. found anti-NMDA-R antibody expressed both in the hippocampus and prefrontal nerve cell membrane, finally proposing the diagnosis of autoimmune anti-NMDA-R encephalitis. Most of the patients are female (91%), with ages ranging from 4 to 76 years. The average age is 23 years, a birth peak age, although anti-NMDA-R encephalitis is rare during pregnancy. The disorder is characterized by prominent psychosis, dyskinesias, seizures, autonomic disturbance, and central hypoventilation. We report a 24-year-old woman hospitalized at 28 gestational weeks with acute-onset psychosis. Over the course of 3 weeks, her mental status worsened until she fell into a coma. Both serum and cerebrospinal fluid anti-NMDA-R antibodies were found to be positive. At cesarean section, a healthy baby boy was born and a wedge-shaped bilateral ovarian resection was performed. Treatment with corticosteroids, intravenous immunoglobulin, and plasmapheresis can lead to improved outcomes for both mother and baby.

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“…A review of the English literature identified 19 publications reporting 21 cases of anti-NMDAR encephalitis during pregnancy (table 1). [2][3][4][5][6][7][8][13][14][15][16][17][18][19][20][21][22][23][24] Median maternal age was 25 years (range, 18-36 years), and 18 (85.7%) patients required intensive care. A teratoma was found and removed in 10/21 (47.6%) patients.…”

Section: Review Of Previously Reported Patientsmentioning

confidence: 99%

“…[3][4][5][6][7] Other studies proposed that transplacental transfer of NMDAR antibodies can result in acute encephalopathy or death of the newborn or eventually result in autistic-spectrum disorders. 3,[8][9][10] In a study based in an experimental animal model of transplacental transfer of a human monoclonal NMDAR antibody, Jurek et al 11 suggested that antibodies of asymptomatic seropositive pregnant women (without evidence of anti-NMDAR encephalitis) caused developmental and cognitive deficits in the offspring. However, the authors did not provide any experimental evidence that the antibodies from asymptomatic mothers of children with cognitive or neurodevelopmental deficits were pathogenic.…”

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confidence: 99%

Pregnancy outcomes in anti-NMDA receptor encephalitis

Joubert

García‐Serra

Planagumà

et al. 2020

Neurol Neuroimmunol Neuroinflamm

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ObjectiveTo report the effects of anti-NMDA receptor (NMDAR) encephalitis in pregnant patients and their babies.MethodsWe studied a retrospective cohort of patients who developed anti-NMDAR encephalitis during pregnancy or became pregnant while recovering from the encephalitis. In addition, we reviewed the English literature between 2010 and 2019 related to this topic.ResultsWe studied 11 patients; 6 developed anti-NMDAR encephalitis during pregnancy, and 5 became pregnant while recovering. There were no obstetrical complications, but 6 (55%) babies were premature. Ten newborns were healthy, and 1 (9%) developed transient respiratory distress. Nine infants had assessable follow-up (median 18 months; range, 7–96 months), and all showed normal development. We identified 21 cases in the English literature. Obstetrical complications occurred in 7 (33%) pregnancies. Two patients died of septic shock (1 baby successfully delivered), another 2 had miscarriages, and in 2, the pregnancy was terminated. Sixteen babies (76%) were delivered, 9 (56%) premature. At birth, 13/16 (81%) newborns were healthy, 2/16 (13%) had transient neurologic or respiratory symptoms, and 1 (6%) died of brain edema. Follow-up (median 12 months; range, 6–36 months) was reported for 8 children: 7 (88%) showed normal development and behavior, and 1 (13%) cortical dysplasia. Immunotherapy was used during pregnancy in 7 (64%) of our patients and 18 (86%) of the reported cases, including rituximab in 4 cases, without adverse effects.ConclusionsPatients who develop anti-NMDAR encephalitis during pregnancy or become pregnant during recovery often have obstetrical complications, but most of the newborns are healthy and appear to have normal development.

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Maternal-Fetal Transfer of Anti–N-Methyl-D-Aspartate Receptor Antibodies

Abstract: Anti-N-methyl-D-aspartate receptor encephalitis in pregnancy can lead to NMDA receptor antibodies in the fetal circulation. Pregnancy interruption through early delivery with or without oophorectomy may accelerate maternal recovery.

Cited by 28 publications

References 12 publications

Anti‐N‐methyl‐d‐aspartate receptor encephalitis during pregnancy: A case report

Anti‐N‐methyl‐d‐aspartate receptor encephalitis during pregnancy: A case report

Anti‐NMDA‐receptor encephalitis during pregnancy: A case report and literature review

Pregnancy outcomes in anti-NMDA receptor encephalitis

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