Pregnancy, child bearing and prevention of giving birth to the affected children in patients with primary immunodeficiency disease; a case-series

Abstract

BackgroundPatients with primary immunodeficiency disease (PID) who survive to adulthood and willing to have a child mostly are worried whether their disease affects their fertility and/or pregnancy and also if their child would be predisposed to PID.Case presentationWe report the outcome of conception, pregnancy and their management in 9 families with definite diagnosis of PID. A chronic granulomatous disease subject with an uneventful pregnancy developed fungal sacral osteomyelitis few weeks after delivery. A pregnant common variable immunodeficiency disease (CVID) patient with idiopathic thrombocytopenia had platelet count dropped before delivery. A sever neutropenic mother who refused to get IFNγ delivered two healthy children. A CVID case intolerant to IVIg with eclampsia and PTE delivered a baby. Another CVID female gave birth to a baby without being on any treatment since she was not diagnosed with immunodeficiency disease at that time. A healthy girl was implanted via preimplantation gender selection in a family who owned a Wiskott Aldrich-affected son. A family who had two children with Ataxia Telangiectasia used donated oocyte for their 3rd child. Prenatal genetic diagnosis was used to screen the fetus for the impaired BTK and CVID genes detected in sibling and father respectively in 2 separate families.ConclusionPregnancy in PID patients is more complex than normal population. Because, not only it has the chance of being inherited by the offspring, but also there are some risks for the mother if she has any kind of immunity component defects. So consultation with a clinical geneticist is crucial to choose the best available approach. They also should be observed and followed by a clinical immunologist to take the best possible safe care.

Blocking Placental Class G Immunoglobulin Transfer Prevents NMDA Receptor Antibody Effects in Newborn Mice

“…38 However, efficiently blocking placental IgG transfer may lead to a transient hypogammaglobulinemia in the infant. If so, this newborn with reduced maternal protective antibodies would be more prone to infections until its own immune system restores IgG levels, at around age 6 months, as reported in pregnancies of patients with genetic primary immunodeficiencies 39 or in those with immunosuppressive treatment during pregnancy (e.g., rituximab). 40 Although no signs of infection were observed in the newborn mice that received FcRn-ab in our model, the possibility of IgG replacement therapy in the infants should be considered.…”

Features of primary immunodeficiency during pregnancy: clinical case

“…И IgG, и IgA на протяжении всей беременности снижаются до уровня 60-70 % (на 37-41 неделе беременности) [9] от исходной концентрации на ранних сроках беременности. Это указывает на необходимость увеличения дозы IgG во время большинства беременностей для поддержания стабильного минимального уровня IgG у матери и достаточного поступления IgG к плоду [10]. Профилактическое применение антибиотиков, низкие дозы иммуноглобулинов недостаточны для защиты от инфекционных заболеваний во время беременности [4].…”

Prenatal stress, anxiety and depression alter transcripts, proteins and pathways associated with immune responses at the maternal-fetal interface

“…Primary immunodeficiency disease (PID) is a disorder where components of the immune system are missing or compromised [ 38 ]; and likely transferred to the newborn [ 39 ]. This pathway involves a group of genes (including CD8α, ILR7α , and TAC1 ; downregulated in the Index group; FC: −4.23, −4.82, −17.41, respectively) affecting cellular and humoral immunity or nonspecific host defense mechanisms mediated by complement proteins.…”