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Neonatal effects of maternal antiphospholipid syndrome

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Abstract

Antiphospholipid antibodies (aPL) can impair the physiologic development of a fetus during pregnancy not only by causing thrombosis of the placental vessels, but also by directly binding throphoblast cells and modifying their functions. Consequently, the presence of aPL in pregnant women is linked to an increased rate of pregnancy complications. These include recurrent early miscarriages, late fetal losses, and hypertensive disorders of gestation. In this clinical setting, preeclampsia is usually early and severe and can be complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). The close association between aPL and obstetric pathology supports the inclusion of these manifestations in the clinical classification criteria of antiphospholipid syndrome. About 30% of children born to mothers with aPL passively acquire these autoantibodies; fortunately, the occurrence of thrombosis seems extremely rare in these babies. The prospective ongoing studies of children born to antiphospholipid syndrome patients reassure us about their general good health; however, some data suggest that learning difficulties might occur, possibly related to in utero exposure to aPL.

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References and Recommended Reading

  1. Soulier JP, Boffa MC: Avortments à repetition, thromboses et anticoagulant circulant antithromboplastin. Nouv Presse Med 1980, 9:859–864.

    Google Scholar 

  2. Harris EN, Gharavi AE, Boey ML, et al.: Anticardiolipin antibodies: detection by radioimmunoassay and association with thrombosis in systemic lupus erythematosus. Lancet 1983, 2:1211–1214.

    Article  PubMed  CAS  Google Scholar 

  3. Tincani A, Balestrieri G, Danieli E, et al.: Pregnancy complications of the antiphospholipid syndrome. Autoimmunity 2003, 36:27–32.

    Article  PubMed  CAS  Google Scholar 

  4. Lubbe WF, Butler WS, Palmer SJ, Liggins GC.: Fetal survival after prednisone suppression of maternal lupusanticoagulant. Lancet 1983, 1:1361–1363.

    Article  PubMed  CAS  Google Scholar 

  5. 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, 42:1309–1311.

    Article  PubMed  CAS  Google Scholar 

  6. Meroni PL, Gerosa M, Raschi E, et al.: Updating on pathogenic mechanisms 5 of the antiphospholipid antibodies-associated pregnancy loss. Clinic Rev Allerg Immunol 2008, 34:332–337.

    Article  Google Scholar 

  7. Tincani A, Bazzani C, Zingarelli S, Lojacono A: Lupus and the antiphospholipid syndrome in pregnancy and obstetrics: clinical characteristics, diagnosis, pathogenesis and treatment. Semin Thromb Hemost 2008, 34:267–273.

    Article  PubMed  CAS  Google Scholar 

  8. Holers VM, Girardi G, Mo L, et al.: Complement C3 activation is required for antiphospholipid antibody-induced fetal loss. J Exp Med 2002, 195:211–220.

    Article  PubMed  CAS  Google Scholar 

  9. Girardi G, Berman J, Redecha P, et al.: Complement C5a receptors and neutrophils mediate fetal injury in the antiphospholipid syndrome. J Clin Invest 2003, 112:1644–1654.

    PubMed  CAS  Google Scholar 

  10. Shamonki JM, Salmon JE, Hyjek E, Baergen RN: Excessive complement activation is associated with placental injury in patients with antiphospholipid antibodies. Am J Obstet Gynecol 2007, 196:167.e1–e5.

    Article  CAS  Google Scholar 

  11. Cavazzana I, Nebuloni M, Cetin I, et al.: Complement activation in antiphospholipid syndrome: a clue for an inflammatory process? J Autoimmun 2007, 28:160–164.

    Article  PubMed  CAS  Google Scholar 

  12. Martinez de la Torre Y, Buracchi C, Borroni EM, et al.: Protection against inflammation- and autoantibody-caused fetal loss by the chemokine decoy receptor D6. Proc Natl Acad Sci U S A 2007, 104:2319–2324.

    Article  PubMed  CAS  Google Scholar 

  13. Borghi MO, Raschi E, Scurati S, et al.: Effects of a Toll-like receptor antagonist and anti-annexin A2 antibodies on binding and activation of decidual cells by anti-beta2glycoprotein I antibodies. Clin Exp Rheumatol 2007, 2:35.

    Article  Google Scholar 

  14. Meroni PL, Di Simone N, Testoni C, et al.: Antiphospholipid antibodies as cause of pregnancy loss. Lupus 2004, 13:649–652.

    Article  PubMed  CAS  Google Scholar 

  15. Miyakis S, Lockshin MD, Atsumi T, et al.: International Consensus Statement on an update of the classification criteria for definite antiphospholipid syndrome. J Thromb Haemost 2006, 4:295–306.

    Article  PubMed  CAS  Google Scholar 

  16. Oshiro BT, Silver RM, Scott JR, et al.: Antiphospholipid antibodies and fetal death. Obstet Gynecol 1996, 87:489–493.

    Article  PubMed  CAS  Google Scholar 

  17. Rasmussen A, Ravn P: High frequency of congenital thrombophilia in women with pathological pregnancies? Acta Obstet Gynecol Scand 2004, 83:808–817.

    Article  PubMed  Google Scholar 

  18. Asherson RA: New subsets of the antiphospholipid syndrome in 2006: “PRE-APS” (probable APS) and microangiopathic antiphospholipid syndromes (“MAPS”). Autoimmun Rev 2006, 6:76–80.

    Article  PubMed  Google Scholar 

  19. Branch DW, Dudley DJ, Scott JR, Silver RM: Antiphospholipid antibodies and fetal loss. N Engl J Med 1992, 326:952.

    PubMed  CAS  Google Scholar 

  20. Scott RA: Anti-cardiolipin antibodies and pre-eclampsia. Br J Obstet Gynecol 1987, 94:604–605.

    CAS  Google Scholar 

  21. Clark EA, Silver RM, Branch DW: Do antiphospholipid antibodies cause preeclampsia and HELLP syndrome? Curr Rheumatol Rep 2007, 9:219–225.

    Article  PubMed  CAS  Google Scholar 

  22. Faden D, Tincani A, Tanzi P, et al.: Anti-beta 2 glycoprotein I antibodies in a general obstetric population: preliminary results on the prevalence and correlation with pregnancy outcome. Anti-beta2 glycoprotein I antibodies are associated with some obstetrical complications, mainly preeclampsia-eclampsia. Eur J Obstet Gynecol Reprod Biol 1997, 73:37–42.

    Article  PubMed  CAS  Google Scholar 

  23. Asherson RA, Galarza-Maldonado C, Sanin-Blair J: The HELLP syndrome, antiphospholipid antibodies, and syndromes. Clin Rheumatol 2008, 27:1–4.

    Article  PubMed  Google Scholar 

  24. Le Thi Thuong D, Tieulié N, Costedoat N, et al.: The HELLP syndrome in the antiphospholipid syndrome: retrospective study of 16 cases in 15 women. Ann Rheum Dis 2005, 64:273–278.

    Article  PubMed  Google Scholar 

  25. Tsirigotis P, Mantzios G, Pappa V, et al.: Antiphospholipid syndrome: a predisposing factor for early onset HELLP syndrome. Rheumatol Int 2007, 28:171–174.

    Article  PubMed  Google Scholar 

  26. Lima F, Khamashta MA, Buchanan NM, et al.: A study of sixty pregnancies in patients with the antiphospholipid syndrome. Clin Exp Rheumatol 1996, 14:131–136.

    PubMed  CAS  Google Scholar 

  27. Zurgil N, Bakimer R, Tincani A, et al.: Detection of antiphospholipid and anti-DNA antibodies and their idiotypes in newborns of mothers with anti-phospholipid syndrome and SLE. Lupus 1993, 2:233–237.

    Article  PubMed  CAS  Google Scholar 

  28. Cohen SB, Goldenberg M, Rabinovici J, et al.: Anti-cardiolipin antibodies in fetal blood and amniotic fluid derived from patients with the anti-phospholipid syndrome. Hum Reprod 2000, 15:1170–1172.

    Article  PubMed  CAS  Google Scholar 

  29. 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, 23:247–251.

    Article  PubMed  Google Scholar 

  30. Pollard JK, Scott JR, Branch DW: Outcome of children born to women treated during pregnancy for the antiphospholipid syndrome. Obstet Gynecol 1992, 80:365–368.

    PubMed  CAS  Google Scholar 

  31. Botet F, Romera G, Montagut P, et al.: Neonatal outcome in women treated for the antiphospholipid syndrome during pregnancy. J Perinat Med 1997, 25:192–196.

    Article  PubMed  CAS  Google Scholar 

  32. Ruffatti A, Dalla Barba B, Del Ross T, et al.: Outcome of fifty-five newborns of antiphospholipid antibody-positive mothers treated with calcium heparin during pregnancy. Clin Exp Rheumatol 1998, 16:605–610.

    PubMed  CAS  Google Scholar 

  33. Brewster JA, Shaw NJ, Farquharson RG: Neonatal and pediatric outcome of infants born to mothers with antiphospholipid syndrome. J Perinat Med 1999, 27:183–187.

    Article  PubMed  CAS  Google Scholar 

  34. Tincani A, Lojacono A, Taglietti M, et al.: Pregnancy and neonatal outcome in primary antiphospholipid syndrome. Lupus 2002, 11:649.

    Article  PubMed  CAS  Google Scholar 

  35. Boffa MC, Lachassinne E: Infant perinatal thrombosis and antiphospholipid antibodies: a review. Lupus 2007, 16:634–641.

    Article  PubMed  Google Scholar 

  36. Avcin T, Cimaz R, Meroni PL: Recent advances in antiphospholipid antibodies and antiphospholipid syndromes in pediatric populations. Lupus 2002, 11:4–10.

    Article  PubMed  CAS  Google Scholar 

  37. Boffa MC, Aurousseau MH, Lachassinne E, et al.: European register of babies born to mothers with antiphospholipid syndrome. Lupus 2004, 13:713–717.

    Article  PubMed  CAS  Google Scholar 

  38. Blank M, Shoenfeld Y: Beta-2-glycoprotein-I, infections, antiphospholipid syndrome and therapeutic considerations. Clin Immunol 2004, 112:190–199.

    Article  PubMed  CAS  Google Scholar 

  39. Martinuc Porobic J, Avcin T, Bozic B, et al.: Anti-phospholipid antibodies following vaccination with recombinant hepatitis B vaccine. Clin Exp Immunol 2005, 142:377–380.

    Article  PubMed  CAS  Google Scholar 

  40. Chapman J, Shoenfeld Y: Neurological and neuroendocrine cytokine inter-relationship in the antiphospholipid syndrome. Ann N Y Acad Sci 2002, 966:415–424.

    Article  PubMed  CAS  Google Scholar 

  41. Shoenfeld Y, Nahum A, Korczyn AD, et al.: Neuronalbinding antibodies from patients with antiphospholipid syndrome induce cognitive deficits following intrathecal passive transfer. Lupus 2003, 12:436–442.

    Article  PubMed  CAS  Google Scholar 

  42. Kent M, Alvarez F, Vogt E, et al.: Monoclonal antiphosphatidylserine antibodies react directly with feline and murine central nervous system. J Rheumatol 1997, 24:1725–1733.

    PubMed  CAS  Google Scholar 

  43. Muscal E, Brey RL: Neurological manifestations of the antiphospholipid syndrome: integrating molecular and clinical lessons. Curr Rheumathol Rep 2008, 10:67–73.

    Article  CAS  Google Scholar 

  44. Prendiville JS, Cabral DA, Poskitt KJ, et al.: Central nervous system involvement in neonatal lupus erythematosus. Pediatr Dermatol 2003, 20:60–67.

    Article  PubMed  Google Scholar 

  45. Zuppa AA, Gallini F, De Luca D, et al.: Cerebral ultrasound findings in neonatal lupus syndrome. Biol Neonate 2004, 86:230–234.

    Article  PubMed  CAS  Google Scholar 

  46. Inoue K, Fukushige J, Ohno T, et al.: Central nervous system vasculopathy associated with neonatal lupus. Pediatr Neurol 2002, 26:68–70.

    Article  PubMed  Google Scholar 

  47. McAllister DL, Kaplan BJ, Edworthy SM, et al.: The influence of systemic lupus erythematosus on fetal development: cognitive, behavioral, and health trends. Int Neuropsychol Soc 1997, 3:370–376.

    CAS  Google Scholar 

  48. Ross G, Sammaritano L, Nass R, Lockshin M: Effects of mothers’ autoimmune diseases during pregnancy on learning disabilities and hand preference in their children. Arch Pediatr Adolesc Med 2003, 157:397–402.

    Article  PubMed  Google Scholar 

  49. Neri F, Chimini L, Bonomi F, et al.: Neuropsychological development of children born to patients with systemic lupus erythematosus. Lupus 2004, 13:805–811.

    Article  PubMed  CAS  Google Scholar 

  50. Nacinovich R, Galli J, Bomba M, et al.: Neuropsycological development of children born to patients with antiphospholipid syndrome. Arthritis Rheum 2008, 59:345–351.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Reumatologia e Immunologia Clinica, Spedali Civili e Università di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy

    Angela Tincani

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  1. Angela Tincani
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  2. Chiara Biasini Rebaioli
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  3. Laura Andreoli
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  4. Andrea Lojacono
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  5. Mario Motta
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Correspondence to Angela Tincani.

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Tincani, A., Rebaioli, C.B., Andreoli, L. et al. Neonatal effects of maternal antiphospholipid syndrome. Curr Rheumatol Rep 11, 70–76 (2009). https://doi.org/10.1007/s11926-009-0010-8

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