Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


European Registry of Babies Born to Mothers with Antiphospholipid Syndrome.

Mekinian1,  Arsene, loire-Berson2,  Priscille, Lachassinne3,  Eric, nicaise-Roland4,  Pascale, Vicaut5,  Eric, Stirnemann6,  Jerome, chollet-Martin4,  Sylvie

Jean Verdier Hospital, Bondy, France
CHU poitiers, Poitiers, France
University Children's Hospital Ljubljana, Ljubljana, Slovenia
University Children's Hospital Ljubljana, Slovenie, Slovenia
Rheumatology, Brescia, Italy
Rheumatology, Milan, Italy
Bondy, France
Service d'hématologie biologique, Université Paris 13, AP-HP, Hôpital Jean Verdier, 93140, Bondy, France., Bondy, France
Service de gynécologie-obstétrique, Université Paris 13, AP-HP, Hôpital Jean Verdier, 93140, Bondy, France., Bondy, France
Service de néonatologie et pédiatrie, Université Paris 13, AP-HP, Hôpital Jean Verdier, 93140, Bondy, France., Bondy, France
Unité Fonctionnelles d'Immunologie Autoimmunité et Hypersensibilités, AP-HP, Hôpital Bichat-Claude Bernard, Paris, Paris, France
Paris, France
Service de médecine interne, Université Paris 13, AP-HP, Hôpital Jean Verdier, 93140, Bondy, France., Bondy, France
Obstetric and Gynecology of Brescia, Brescia, Italy
Rheumathology Unit, University of Brescia, Brescia, Italy, Brescia, Italy
Hemostase Poitiers, Poitiers, France

Background/Purpose:

To describe the outcome and the immunological status of children born to mothers with antiphospholipid syndrome (APS), to determine the factors responsibles of children abnormalities, to correlate childrens immunological status to mother's antibodies.

Methods:

A prospective follow up of a European multicentric cohort of 130 children born to mothers with APS. Both maternal (clinical features, history, pregnancy features, immunological status) and infant's data at birth were recorded. A clinical, developmental and immunological follow up of infants at 1 to 3, 9 to 12, 24 months and 5 years was performed.

Results:

One hundred forty women with APS (Sapporo) (mean age 36±5 years) were included. Eighty one percent of the mothers (n=115) have primary APS and the purely obstetrical APS represents 79% of the cohort (n=111). During pregnancy, treatment with aspirin-low molecular weight heparin was present in 125 cases (90%), steroids in 25 cases (18%), and hydroxychloroquine in 15 cases (11%).

One hundred thirty children born to mothers with APS were analyzed (female sex in 61 cases, birth weight 3000±500 g, height 48±3 cm, cranial perimeter 34±3 cm). Seventeen percent have a premature birth (n=22), and fifteen percent presented birth weight <2500 g (n=19). Thrombopenia was noted in 2 children, without any case of lupus or thrombosis. Four percent of children have lupus anticoagulant and antibeta2GP1 IgG antibodies (n=4), fifteen percent have anticardiolipid IgG antibodies at birth (n=17) (table).

 Cordon (n=40)First week (n=110)3 months (n=35)9 months (n=38)24 months (n=49)
ACC04 (4%)1 (3%)1 (3%)0
Anticardiolipid IgG7 (18%)17 (15%)3 (9%)7 (18%)11 (22%)
Anticardiolipid IgM00001 (2%)
AntiB2GP1 IgG2 (5%)4 (4%)5 (14%)7 (18%)5 (10%)
AntiB2GP1 IgM00001 (2%)

During 5 year follow-up, four children displayed behavioural abnormalities between 3 months and three years of age (psychomotor development delay with axial hypertonia, autism, attention-deficit/hyperactive disorder and language delay, growth failure and language delay (n=1 each)). No thrombosis or lupus was noted during follow-up. Eighteen percent have anticardiolipid IgG and antibeta2GP1 IgG antibodies above 6 months (table). Among children with abnormal psychomotor development, one has persistent anticardiolipid IgG antibodies.

Anticardiolipid Ig G and antibeta2GP1 Ig G antibodies in children, even after 6 months, were correlated with the same antibodies in mother (p<0.05).

The presence of maternal lupus with odds ratio 4 [1.2; 15]) and anticardiolipid IgG (odds ratio 6 [1.1; 33]) were predictive of neonates complication, whereas the presence of previous placenta praevia and mother's anticardiolipid IgG antibody were predictive of complications in children at 3 and 9 months.

Conclusion:

Despite a high rate of premature birth and persistent antiphospholipid antibodies, the children born to mothers with APS do not have significant abnormalities of psychomotor development, thrombosis or lupus. The significance of persistent antibodies in children is not actually established.

To cite this abstract, please use the following information:
Mekinian, Arsene, loire-Berson, Priscille, Lachassinne, Eric, nicaise-Roland, Pascale, Vicaut, Eric, Stirnemann, Jerome, et al; European Registry of Babies Born to Mothers with Antiphospholipid Syndrome. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :728
DOI:

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