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1.
Lupus ; 26(5): 552-558, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28394231

RESUMO

Background Systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS) are autoimmune diseases that affect women of childbearing age. Maternal IgG antiphospholipid antibodies (aPL) can cross the placenta during pregnancy and theoretically reach the fetal brain. Some studies showed an increased number of learning disabilities in these children. Objectives To evaluate the long-term neurodevelopmental outcome of 40 children (median age 7.4 years) born to mothers with SLE and/or APS carrying positive IgG aPL during the third trimester of pregnancy. Methods Children were checked for neurological physical exam and intellectual/cognitive functioning by the Wechsler scale for corrected age. We submitted to the mothers the Child Behavior CheckList (CBCL) and a homemade set of questions created by pediatric neurologists. Results In all children neurological physical exam and intelligence levels were found to be normal. A cognitive impairment or a discrepant cognitive profile was found in 3 (7%) and 11 (28%) children, respectively. Learning disabilities were diagnosed in 3 children (19% of school-age children), all born to mothers with triple aPL positivity. A history of epilepsy was shown in four children (10%). CONCLUSIONS: Children born to women with SLE and/or APS may need a long-term follow-up focusing on milestones of neurodevelopment in order to detect and correct any alteration as early as possible.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Síndrome Antifosfolipídica/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal/psicologia , Adolescente , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticorpos Antifosfolipídeos/metabolismo , Criança , Pré-Escolar , Disfunção Cognitiva/epidemiologia , Epilepsia/epidemiologia , Feminino , Humanos , Deficiências da Aprendizagem/epidemiologia , Lúpus Eritematoso Sistêmico/complicações , Masculino , Gravidez , Terceiro Trimestre da Gravidez/imunologia , Efeitos Tardios da Exposição Pré-Natal/etiologia , Escalas de Wechsler
2.
Ann Rheum Dis ; 76(3): 476-485, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27457513

RESUMO

OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). METHODS: Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. RESULTS: Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease. CONCLUSIONS: Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.


Assuntos
Síndrome Antifosfolipídica/tratamento farmacológico , Neoplasias dos Genitais Femininos/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Anticoncepcionais Orais Hormonais/uso terapêutico , Técnica Delphi , Detecção Precoce de Câncer , Terapia de Reposição de Estrogênios , Serviços de Planejamento Familiar , Feminino , Preservação da Fertilidade , Monitorização Fetal , Humanos , Menopausa , Cuidado Pré-Concepcional , Gravidez , Técnicas de Reprodução Assistida , Medição de Risco
3.
Lupus ; 23(12): 1246-8, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25228716

RESUMO

BACKGROUND: Systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS) are autoimmune diseases that affect women of childbearing age. Pregnancies in these patients carry several complications such as prematurity. Maternal IgG antiphospholipid antibodies (aPL) can cross the placenta but they don't generally cause any neonatal thrombotic event. Because of the incompleteness of the fetal blood-brain barrier, aPL could theoretically reach the fetal brain. Whether this can have an effect on brain development is still under investigation. Some studies performed in children of patients with SLE and/or APS showed an increased number of learning disabilities without impairment in intelligence level. OBJECTIVES: The objectives of this article are to evaluate the neurodevelopment outcome in 30 children (median age 9 years) born to mothers with SLE and/or APS with IgG anti-beta2-glycoprotein I during the third trimester of pregnancy and found positive for the same antibodies at birth. METHODS: A neurological physical exam was performed in all children. We submitted some questionnaires to the mothers: the Child Behavior CheckList (CBCL) and a homemade set of questions obtained by a team composed of rheumatologists and pediatric neurologists. Intellectual functioning was determined by the Wechsler scale for corrected age. RESULTS: In all children neurological physical exam and intelligence levels were found to be normal but mild behavior disorders and history of neurological manifestations were shown in three children. CONCLUSIONS: Offspring of patients with SLE and/or APS are generally healthy. We and others observed the occurrence of minor neurological disorders that might be related to maternal disease or to prematurity. The limited number of the available data on this sensitive issue supports the need for further studies.


Assuntos
Síndrome Antifosfolipídica/complicações , Lúpus Eritematoso Sistêmico/complicações , Complicações na Gravidez , Anticorpos Antifosfolipídeos/sangue , Criança , Transtornos do Comportamento Infantil/etiologia , Desenvolvimento Infantil , Feminino , Humanos , Masculino , Gravidez
5.
Lupus ; 23(6): 507-17, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24763535

RESUMO

Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease that primarily affects women of childbearing-age. Antiphospholipid syndrome (APS) is a systemic autoimmune disorder defined by the occurrence of venous and arterial thrombosis, often multiple, and pregnancy morbidity in the presence of antiphospholipid antibodies (aPL). Recently, the long-term outcome of children born to patients with lupus and APS has become a major topic of interest both to patients and physicians. One of the major problems related to maternal disease is preterm delivery with all the consequences that this condition may bring. Prematurity may also be due to the presence of aPL; however, aPL do not generally display any thrombotic potential on neonates. Another complication may be neonatal lupus (NL), mediated by the presence of maternal antibodies (anti-Ro/SSA and anti-La/SSB). In addition, behaviour and neuropsychological outcomes have also been a matter of interest, but there are currently few data available. Beyond the biological influence of both maternal disease and autoimmune background, it is important to focus on the possible influence of maternal chronic illness on the neuropsychological development of her children. Whether aPL exposure could have a direct effect on brain development is still being debated. In children of mothers with APS, language delays have been noted and learning disabilities were described with a higher rate than the general age-school population. Several studies were performed on children born to lupus mothers: even if maternal lupus does not seem to impair intelligence levels, it may increase the occurrence of learning disabilities and particularly dyslexia in male children. To the best of our knowledge, no studies are available on the long-term outcome of children born to mothers with lupus or APS and particularly regarding the development of autoimmune diseases. Nevertheless, common experience of experts in the field is that these children do not show a significantly increased risk of displaying the same autoimmune disease as their mothers. The purpose of this paper is to answer the frequently asked questions of patients with lupus and APS who desire to become mothers, based on the little information available.


Assuntos
Síndrome Antifosfolipídica/complicações , Lúpus Eritematoso Sistêmico/congênito , Lúpus Eritematoso Sistêmico/complicações , Transtornos Mentais/etiologia , Nascimento Prematuro/etiologia , Efeitos Tardios da Exposição Pré-Natal , Fatores Etários , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/imunologia , Criança , Comportamento Infantil , Transtornos do Comportamento Infantil/etiologia , Desenvolvimento Infantil , Pré-Escolar , Feminino , Humanos , Imunossupressores/efeitos adversos , Lactente , Recém-Nascido , Inteligência , Deficiências da Aprendizagem/etiologia , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/etiologia , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Transtornos Mentais/fisiopatologia , Transtornos Mentais/psicologia , Sistema Nervoso/crescimento & desenvolvimento , Gravidez , Prognóstico , Medição de Risco , Fatores de Risco
6.
Pregnancy Hypertens ; 2(3): 272-3, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26105380

RESUMO

INTRODUCTION: Uterine artery (UtA) Pulsatility index assessed in the second trimester is known to be the best predictor of Pre-eclampsia (PE) in women with risk factors. The role of this index when PE occurs seems to be related with clinical outcome. OBJECTIVES: To detect if there does exist a correlation between mean UtA PI, assessed at diagnosis of PE, and: (A) Gestational Age (GA) at delivery; (B) birth weight (BW) percentile. To detect the predictive value of mean UtA PI and the development of adverse pregnancy outcome (APO). METHODS: Cohort study on 100 consecutive singleton pregnancies complicated with pre-eclampsia referred to our Department from January 2010 and December 2011. Doppler evaluations were performed from diagnosis to delivery. Mean UtA PI obtained at time of diagnosis of PE were analysed. PE was defined according to ISSHP criteria. Clinical and perinatal outcomes were reviewed. APO was defined as Apgar score less than 7 at five minutes, pH <7.20; birth weight <5th percentile (SGA), stillbirth or neonatal death. Receiver-operating characteristics (ROC) curve was used to determine the predictive ability for subsequent development of APO. RESULTS: Maternal characteristics and main pregnancy outcomes are shown in Table 1. Fifty-six pregnancies developed APO. One case of stillbirth and four cases of neonatal death were observed. SGA occurred in 56/100 neonates; 52/95 (55%) live births were admitted to Neonatal Intensive Care Unit. Table 1. Mean UtA PI at diagnosis of PE was 1.40 (SD±0.28) in women that developed APO and 1.10 (SD±0.41) in women that did not develop APO (p=0.02). Pearson's Correlation coefficient for mean UtA PI and GA at Delivery was -0.533 (p=0.002); while for mean UtA PI and BW percentile was -0.466 (p=0.007). The prediction of subsequent development of APO, expressed as the area under ROC curve, was 61.6 (95% CI 0.44-0.79) for UtA PI at Diagnosis of PE. CONCLUSION: Our data confirm that mean UtA PI, assessed at diagnosis of PE, represent a good independent predictor for GA at delivery end BW percentile. However the predictive value for development of APO seems to be poor.

7.
Pregnancy Hypertens ; 2(3): 319-20, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26105470

RESUMO

INTRODUCTION: Pre-eclampsia (PE) is a leading cause of maternal and foetal mortality and morbidity. Chronic Hypertension (CH) and a previous PE are well known risk factors for PE. If the prevalence of PE in nulliparous is about 2%, it raise up to 7-10% in women with CH or a previous PE. However, the role of these risk factors when PE occurs is still under discussion OBJECTIVES: To detect if maternal history of previous PE and/or Chronic Hypertension (CH) is associated with a worse clinical outcome in women affected by PE. METHODS: Cohort study on 100 consecutive singleton pregnancies complicated by PE referred to our Department from January 2010 to December 2011. PE and CH were defined according to ISSHP criteria. Small for Gestational Age (SGA) was defined as Birth Weight under the 5th percentile per Gestational Age. Patients were divided into two groups depending on positive (Group A, n=25) or negative (Group B, n=75) history for PE and/or Chronic Hypertension (CH). Patients assessed to group A were under prophylactic therapy with ASA 100mg oid. Clinical and perinatal outcomes were reviewed. Adverse Pregnancy Outcome (APO) was defined as Apgar score less than seven at five minutes, pH<7.20; birth weight<5th percentile (SGA), stillbirth or neonatal death. RESULTS: Groups were comparable for Maternal Age (Group A: 34years median, IQR 30-36yy; Group B: 34years, IQD 28-36yy ) and BMI (Group A: 23.7Kg/mq median, IQR 20.8-27.1Kg/mq; Group B: 22.4Kg/mq median IQR 20.3-26.0Kg/mq). One case of stillbirth (Group A) and four cases of neonatal death were observed, 1/25 in Group A (4%) and 3/75 (4%) in Group B. No differences were found in Gestational Age (GA) at diagnosis of PE (Group A: 32+2w median, IQR 28+0-35+4w; Group B: 33+2w median, IQR 30+0-36+1w); GA at delivery (Group A: 34+1w median, IQR 31+5-36+5w; Group B: 34+2w median, IQR 32+0-36+3w) Birth Weight percentile (Group A: 6th percentile median, IQR 2-21th percentile; Group B: 5th percentile median, IQR 1-15th percentile), prevalence of Small for Gestational Age (14/25 and 42/75, for Group A and B respectively), prevalence of APO (13/25 and 44/75, for Group A and B respectively). CONCLUSION: Our data suggest that a positive history for PE and/or CH does not influence clinical outcome in women affected by PE. This result could be explained by the administration of prophylactic ASA 100mg oid in this group of patients.

8.
Pregnancy Hypertens ; 2(3): 333-4, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26105494

RESUMO

INTRODUCTION: Chronic hypertension (CH) is a common disorder occurring in approximately 1-5% of pregnant women. Many studies emphasize that the development of superimposed preeclampsia (PE) is associated with high rates of adverse pregnancy outcome. Accurate prediction of women at risk for PE is crucial to judicious allocation of monitoring resources and use of preventive treatment, in order to improve maternal and neonatal outcome. Recent systematic review and meta-analysis showed that mean arterial pressure (MAP) is a better predictor for pre-eclampsia than systolic blood pressure and diastolic blood pressure OBJECTIVES: To detect the value of MAP in the first and second trimesters to predict PE in women with CH. To determine if MAP, assessed in the second trimester, can increase the predictive value for PE of II trimester UtA PI. METHODS: Cohort study on 100 consecutive singleton pregnancies complicated with CH referred to our Department from January 2008 to June 2011. Blood pressure was measured by a mercury sphygmomanometer at 11-14+6w and 23+0-25+6w, MAP was calculated. Doppler-velocimetry was performed at 23+0-25+6w, mean UtA PI was calculated. PE and CH were defined according to ISSHP criteria. Clinical and perinatal outcomes were reviewed. Receiver-operating characteristic (ROC) curves were used to determine the predictive ability of I and II trimesters MAP and II trimester mean UtA PI for subsequent development of PE. Logistic regression analysis was run to assess the additional value of II trimester MAP to II trimester UtA PI. RESULTS: Mean maternal age was 36 years (SD ±5yy); mean Body mass Index was 24Kg/mq (SD ±5Kg/mq); GA at I Trimester evaluation was 11+4w (SD ±1+5w); I trimester MAP was 100.46mmHg (mean, SD ±9.94mmHg); GA at Doppler and II trimester MAP was 24+4w (SD ±4dd); II trimester MAP 97.53mmHg (mean, SD ±10.27mmHg). Nineteen cases of PE were observed. Seventy patients were under prophylactic ASA 100mg oid. Fifty-two patients were under anti-hypertensive therapy from the first trimester. No differences in prevalence of PE were observed between patients in and out prophylactic treatment, as well as no differences in prevalence of PE were observed between patients under anti-hypertensive treatment or not. The prediction of subsequent development of PE, expressed as the area under ROC curve, was 0.469 (95% CI 0.34-0.59) for I trimester MAP; 0.659 (95% CI 0.55-0.76) for II trimester MAP; 0.748 (95% CI 0.65-0.83) for II trimester mean UtA PI; GA at delivery was 37+4w(mean, SD ±3+2w); mean BW was 2958g (SD ±735g); BW percentile was 38 (mean SD ±29 percentiles); mean BW z-Score was -0.63 (SD ±1.6). Logistic regression analysis showed that MAP does not increase the predictive ability of II trimester UtA PI in women with CH. CONCLUSION: In our findings, MAP seems not to be a good predictor for subsequent development of PE in women with CH, moreover, it seems to be not useful to increase the predictive value for PE of II trimester UtA PI. II trimester UtA PI has been confirmed to be the best predictor for subsequent development of PE.

9.
Reumatismo ; 63(2): 91-6, 2011.
Artigo em Italiano | MEDLINE | ID: mdl-21776445

RESUMO

OBJECTIVE: Anti-ß2 GPI are a formal laboratory criterion for the antiphospholipid syndrome (APS). They were demonstrated to be a risk factor for thrombosis and fetal losses but can also be detected in patients with systemic autoimmune disease (SAD), in healthy adults individuals and pre-school children. It has been suggested that different subpopulations of anti-ß2GPI may carry different pathogenetic potential: autoantibodies against Domain1 seem to be associated with thrombosis; autoantibodies against Domain4/5 have been identified in patients with non-thrombotic conditions. METHODS: We studied 48 patients with SAD (32 systemic lupus erythematosus, 16 undifferentiated connettive tissue disease), 64 patients with APS, 57 one-year-old healthy children born to mother with SAD, 33 children with atopic dermatitis. All subjects were IgG anti-ß2 GPI positive. The specificity of anti-ß2 GPI was investigated using ELISA research products containing recombinant ß2 GPI D1 and D4/5 antigens. Cut-off values are calculated as 95th percentile on 100 NHD. IgG anti-ß2 GPI were tested at a validated home-made ELISA routinely performed in our laboratory. No thrombotic events were recordered in patients with SAD and in both groups of children. RESULTS: Patients with SAD and APS showed prevalent reactivity for D1 while children in both groups preferentially recognize D4/5. CONCLUSIONS: IgG anti-ß2 GPI against D1 seem to cluster in patients with systemic autoimmune conditions. Their pathogenic potential in determine APS manifestations may be mitigated by adequate prophylaxis.


Assuntos
Autoanticorpos/imunologia , Autoantígenos/imunologia , Doenças Autoimunes/imunologia , beta 2-Glicoproteína I/imunologia , Adolescente , Adulto , Idoso , Especificidade de Anticorpos , Autoanticorpos/sangue , Autoantígenos/química , Doenças Autoimunes/sangue , Doenças do Tecido Conjuntivo/sangue , Doenças do Tecido Conjuntivo/imunologia , Dermatite Atópica/sangue , Dermatite Atópica/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunidade Materno-Adquirida/imunologia , Lactente , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Pessoa de Meia-Idade , Modelos Imunológicos , Gravidez , Complicações na Gravidez/imunologia , Estrutura Terciária de Proteína , Adulto Jovem , beta 2-Glicoproteína I/química
10.
Minerva Pediatr ; 62(3 Suppl 1): 25-7, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21089714

RESUMO

The registry is an European, multicentre, prospective and longitudinal study which follows a cohort of children born to mothers with antiphospholipid syndrome (APS). In this article we report preliminary results obtained from 138 mothers and 141 babies (three twin pregnancies). At birth, 16.3% of neonates were less than 37 weeks of gestation and 17% were low birth weight; in addition, 11.3% of neonates were small for gestational age. No cases of neonatal thrombosis were observed. During follow-up period five children showed behavioral abnormalities. A long term clinical follow-up will be necessary to evaluate the neuropsychological development of these children.


Assuntos
Síndrome Antifosfolipídica/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Sistema de Registros , Anticorpos Antifosfolipídeos/sangue , Transtorno Autístico/epidemiologia , Transtorno Autístico/etiologia , Pré-Escolar , Europa (Continente) , Feminino , Seguimentos , Humanos , Imunidade Materno-Adquirida , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Recém-Nascido de muito Baixo Peso , Deficiências da Aprendizagem/epidemiologia , Deficiências da Aprendizagem/etiologia , Gravidez , Gravidez Múltipla , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Transtornos Psicomotores/epidemiologia , Transtornos Psicomotores/etiologia , Trombose/congênito , Trombose/epidemiologia , Gêmeos
11.
Reumatismo ; 62(3): 189-94, 2010.
Artigo em Italiano | MEDLINE | ID: mdl-21052565

RESUMO

OBJECTIVE: Anti-ß2glycoprotein I antibodies (a-ß2GPI) are a laboratory criterion for the antiphospholipid syndrome (APS) and were demonstrated to be involved in the pathogenesis of APS. However, they can also be detected in asymptomatic subjects. It has been suggested that a-ß2GPI against Domain1 (D1) associate with thrombosis, while those recognizing Domain4/5 (D4/5) have been identified in non-thrombotic conditions. We evaluate the specificity of a-ß2GPI in different clinical situations. METHODS: We studied 39 one-year-old healthy children born to mothers with systemic autoimmune diseases (SAD) (15 (38.4%) were born to mothers who were a-ß2GPI positive), 33 children with atopic dermatitis (AD) and 55 patients with APS (50 adults and 5 paediatrics). All subjects were IgG a-ß2GPI positive. IgG a-ß2GPI were performed by homemade ELISA, while IgG a-ß2GPI D1 and D4/5 were tested on research ELISAs containing recombinant ß2GPI domains antigens. RESULTS: One-year-old children and AD children displayed preferential reactivity for D4/5; patients with APS recognized preferentially D1. We also found a good correlation between a-ß2GPI and D4/5 in one-year-old (r=0.853) and AD children (r=0.879) and between a-ß2GPI and D1 in the APS group (r=0.575). No thrombotic events were recorded in both groups of children. CONCLUSIONS: A-ß2GPI found in non-thrombotic conditions (healthy children born to mothers with SAD and AD children) mostly recognize D4/5, in contrast to the prevalent specificity for D1 in the APS group. The different specificity could at least partially explain the "innocent" profile of a-ß2GPI in children.


Assuntos
Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/imunologia , Imunoglobulina G/imunologia , Trombofilia/imunologia , beta 2-Glicoproteína I/imunologia , Adulto , Especificidade de Anticorpos , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/complicações , Doenças Autoimunes/sangue , Doenças Autoimunes/imunologia , Dermatite Atópica/sangue , Dermatite Atópica/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/classificação , Lactente , Recém-Nascido , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/imunologia , Estrutura Terciária de Proteína , Proteínas Recombinantes/imunologia , Trombofilia/etiologia , beta 2-Glicoproteína I/química
12.
Clin Exp Rheumatol ; 28(5): 767-73, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20822715

RESUMO

A chronic disease may have an adverse impact on patients' quality of life and on their relationship styles. If this occurs in a mother, the related emotional and physical distress can interfere with baby holding, impacting on the antenatal maternal-foetal attachment and on the upbringing and development of the baby. Ineffective holding leads to the persistence of a condition of 'vulnerability to stress' and the possible development of psychosomatic problems in the offspring. In this paper we present our experience and a review from the current literature on the psychological aspects of pregnancy and parenthood in women with rheumatic diseases (RD) and children's development. To ameliorate family global quality of life, different experts (the rheumatologist, the obstetric, the neonatologist, the psychologist and the neuropsychiatric experts) should cooperate in teamwork to keep the patients' needs integrated. In particular, the neuropsychiatric intervention might support the patients and their partners throughout the experience of pregnancy and parenthood and prevent the occurrence of psychopathologic traits.


Assuntos
Transtornos do Comportamento Infantil/terapia , Desenvolvimento Infantil , Poder Familiar/psicologia , Complicações na Gravidez/psicologia , Doenças Reumáticas/psicologia , Adaptação Psicológica , Adulto , Criança , Transtornos do Comportamento Infantil/etiologia , Transtornos do Comportamento Infantil/psicologia , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Comportamento Materno , Testes Neuropsicológicos , Gravidez , Qualidade de Vida
13.
Arthritis Rheum ; 59(3): 345-51, 2008 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-18311760

RESUMO

OBJECTIVE: To verify the occurrence of learning disabilities (LDs) in the offspring of women with primary antiphospholipid syndrome (APS) as a consequence of fetal exposure to maternal antiphospholipid antibodies (aPL), and to evaluate the impact of maternal chronic disease on children's development. METHODS: We studied 17 children of mothers with primary APS using a standardized intelligence test (Wechsler Intelligence Scale for Children, Revised), a specific LD battery of tests (Sartori, MT groups' test for reading ability, MT groups' test for math skills), and a questionnaire on behavioral and social characteristics (Child Behavior Checklist [CBCL]). Mothers were interviewed about their pregnancy and motherhood experience. RESULTS: All children had a normal intelligence level (full-scale intelligence quotient >85); 15 pregnancies occurred in mothers with IgG aPL. LDs were diagnosed in 4 children (26.7%), 2 boys and 2 girls. One of these children was born premature, with a brother also affected. Four children (26.7%) showed a higher risk to present problems on the CBCL total competence scale and 2 children (13.3%) on the CBCL total behavior scale. Two children were described as hyperactive (1 had an LD). All families had a good socioeconomic status and educational level. CONCLUSION: Besides prematurity and genetic and environmental factors, the genesis of LDs may also include in utero exposure to aPL, in agreement with described experimental models and patients with systemic lupus erythematosus. Socioeconomic status does not seem to influence the occurrence of LDs. A long-term multidisciplinary followup may improve quality of life in patients with primary APS and their children.


Assuntos
Síndrome Antifosfolipídica , Deficiências da Aprendizagem/imunologia , Complicações na Gravidez , Efeitos Tardios da Exposição Pré-Natal/imunologia , Adolescente , Criança , Desenvolvimento Infantil , Feminino , Humanos , Inteligência , Masculino , Gravidez , Escalas de Wechsler
14.
Ultrasound Obstet Gynecol ; 31(1): 65-71, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18157797

RESUMO

OBJECTIVE: To investigate maternal cardiovascular function in pregnancies complicated by intrauterine growth restriction (IUGR). METHODS: Maternal echocardiography and ambulatory blood pressure monitoring were performed in pregnancies complicated by IUGR (n = 12) and controls (n = 12), all of whom were normotensive at enrollment. RESULTS: Compared to controls, maternal blood pressure (P = 0.016) and total vascular resistance (P = 0.008) were higher in IUGR pregnancies. Heart rate was lower (P = 0.003), as was systolic function expressed by midwall fractional shortening (P = 0.04). No significant differences between the two groups were observed for left atrial or left ventricular dimensions, nor for left ventricular geometry. Assessment of diastolic function by means of transmitral Doppler flow measurements revealed a significantly longer isovolumetric relaxation time in pregnancies with IUGR (P = 0.006). CONCLUSIONS: In normotensive pregnancies complicated by IUGR, as compared to controls, there is decreased diastolic and systolic maternal cardiac function, and a higher blood pressure.


Assuntos
Retardo do Crescimento Fetal/diagnóstico por imagem , Hipertensão Induzida pela Gravidez/fisiopatologia , Adulto , Monitorização Ambulatorial da Pressão Arterial/métodos , Estudos de Casos e Controles , Feminino , Retardo do Crescimento Fetal/fisiopatologia , Humanos , Bem-Estar Materno , Gravidez , Resultado do Tratamento , Ultrassonografia Pré-Natal/métodos , Resistência Vascular/fisiologia
15.
Lupus ; 16(8): 600-5, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17711895

RESUMO

In the management of adolescents with systemic lupus erythematosus (SLE), sexual activity and prevention of unwanted pregnancies are important topics. Many contraceptive methods are available nowadays. Oral contraceptives (OCs) are the preferred choice among adolescents in general. However, the use of these medications in adolescents with SLE raises serious concerns, particularly the risk of thrombotic events from estrogen exposure and the impact of these medications on lupus activity. In this article, different contraceptive methods available are reviewed and their application in adolescents with SLE is discussed. In conclusion, OCs are the methods of choice in adolescents with stable disease and no antiphospholipid antibodies (aPL) detected. In patients with aPL, fewer options are available, and the selection of the preferred form of contraception should be made on an individual basis.


Assuntos
Anticoncepção , Hormônios Esteroides Gonadais/fisiologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Lúpus Eritematoso Sistêmico/psicologia , Adolescente , Anticorpos Antifosfolipídeos/sangue , Anticoncepção/métodos , Feminino , Humanos , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/imunologia , Masculino
16.
J Perinatol ; 27(5): 278-83, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17363909

RESUMO

OBJECTIVE: To evaluate the incidence of electrocardiographic and laboratory abnormalities in neonates born from mothers with connective tissue disease and positive for anti-SSA/Ro antibodies. STUDY DESIGN: Electrocardiogram, blood cell counts, liver and renal function tests prospectively obtained from 51 infants born from anti-SSA/Ro-positive mothers with connective tissue disease were compared with those obtained from 50 control infants born from mothers with anti-extractable nuclear antigen (ENA)-negative connective tissue disease. One infant with congenital complete heart block was excluded from analysis. RESULTS: No infant showed sinus bradycardia. A first-degree atrioventricular block at birth was observed in five study group and no control group infants, P=0.023. Atrioventricular blocks spontaneously reverted or remained stable during the first year of life. Mean corrected QT value of infants born from anti-SSA/Ro-positive mothers was slightly prolonged as compared with the control group (0.404+/-0.03 s vs 0.395+/-0.02 s; P=0.060). CONCLUSIONS: Infants exposed to anti-SSA/Ro antibodies had a significantly higher prevalence of first-degree atrioventricular block. At variance with previous studies, we observed a low frequency of hematologic abnormalities and no cases of hepatobiliary disease.


Assuntos
Anticorpos Antinucleares/sangue , Doenças do Tecido Conjuntivo/diagnóstico , Doenças do Recém-Nascido/diagnóstico , Complicações Hematológicas na Gravidez/diagnóstico , Contagem de Células Sanguíneas , Doenças do Tecido Conjuntivo/imunologia , Eletrocardiografia , Feminino , Seguimentos , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/imunologia , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/imunologia , Testes de Função Hepática , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/imunologia , Masculino , Gravidez , Complicações Hematológicas na Gravidez/imunologia , Estudos Prospectivos , Remissão Espontânea
17.
Lupus ; 15(11): 801-7, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17153854

RESUMO

The number of patients affected by systemic lupus erythematosus (SLE) that decide to have children has greatly increased probably because of recent improvements in the diagnosis and management of the disease. This has stimulated our interest in defining the outcome of children, focusing both on neonatal problems and long term development. SLE patients still carry a risk of pregnancy loss. However, due to careful monitoring and treatment by a multidisciplinary team, the number of losses has dramatically decreased, but an increased number of preterm deliveries is still a problem. Neonatal lupus is linked to the presence of anti-Ro/SS-A and anti-La/SS-B antibodies in the mother, although other factors probably of fetal origin are important. Neonatal lupus is a complex condition whose most serious manifestation is the congenital heart block (CHB). Usually, children with complete CHB need permanent pacing, but apparently do not have neuropsychological problems. Studies focusing on the neuropsychological development of SLE offspring show an increased number of learning disabilities in children with normal intelligence levels. Fetal consequence of maternal treatment need to be considered choosing non teratogenic drugs, but the withdrawal of medications just because the patient is pregnant should be avoided to avoid SLE flares.


Assuntos
Lúpus Eritematoso Sistêmico/genética , Sistema Nervoso Central/crescimento & desenvolvimento , Feminino , Predisposição Genética para Doença , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/prevenção & controle , Humanos , Recém-Nascido , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/congênito , Lúpus Eritematoso Sistêmico/terapia , Masculino , Testes Neuropsicológicos , Gravidez , Resultado da Gravidez , Desempenho Psicomotor
18.
Lupus ; 13(10): 805-11, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15540514

RESUMO

To verify the neuropsychological development in the offspring of patients with systemic lupus erythematosus (SLE), 47 children (23 male and 24 female) from affected women were studied. The tests applied were related to the children's ages: Griffiths scale up to four years, WPPSI and metaphonological tests (MP, evaluating the phonological consciousness) from four to six years of age, WISC-R test and Rey test (evaluating the visual-space abilities) from six years onwards; finally, specific tests for the diagnosis of learning disabilities (LD) between the ages of seven and 13. Intelligence levels were always normal (mean IQ score 106.32; median 104; SD 9.05). Three out of eight examined children failed MP, therefore may develop LD and will need further evaluation later. Fourteen children were specifically studied for LD and three reported scores lower than normal, but only two (who were brothers) were defined dyslexic. Antiphospholipid antibodies (aPL) were positive in the mothers of the three children with impaired LD tests. Other maternal autoantibodies or drugs administered during pregnancy did not seem to be related to LD. In conclusion, maternal SLE does not impair intelligence levels, but may increase the occurrence of LD particularly in male children (2/8 males examined, 25%). Both maternal aPL and genetic background may have pathogenetic implications.


Assuntos
Desenvolvimento do Adolescente , Desenvolvimento Infantil , Filho de Pais com Deficiência , Lúpus Eritematoso Sistêmico , Complicações na Gravidez , Adolescente , Anticorpos Antifosfolipídeos/sangue , Criança , Filho de Pais com Deficiência/psicologia , Pré-Escolar , Feminino , Humanos , Incidência , Inteligência , Deficiências da Aprendizagem/epidemiologia , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Testes Neuropsicológicos , Gravidez , Complicações na Gravidez/imunologia , Estudos Prospectivos
19.
J Matern Fetal Neonatal Med ; 16(2): 115-8, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15512722

RESUMO

BACKGROUND: We aimed to establish if epidural analgesia is associated with a higher incidence of operative vaginal delivery, longer duration of labor and more frequent use of oxytocin than labor without analgesia. METHODS: We analyzed a cohort of 207 women with no risk factors who delivered with epidural analgesia in the labor unit of Spedali Civili, Brescia, Italy, during 2001. Length of the first and second stage of labor, mode of delivery, neonatal cord blood pH, neonatal Apgar score and neonatal outcomes were evaluated. RESULTS: Epidural analgesia was performed on request in 6%: in this group (group A) there were 141 (68%) nulliparae and 66 (32%) pluriparae; mean ( +/- standard deviation) gestational age at delivery was 39.4 +/- 1.3 weeks (range: 34.1-41.5 weeks). In this group, 184 (89%) had vaginal delivery and 23 (11%) delivered by Cesarean section. Among controls (group B), 368 (89%) had a vaginal delivery and 46 (11%) delivered by Cesarean section; vacuum extraction was used in 18 deliveries (9%) in group A and in 13 deliveries (3%) in group B. The duration of the second stage of spontaneous labor in the nulliparae of group A was significantly longer than in group B. No statistically significant differences were found between mean umbilical artery pH values of groups A and B. CONCLUSION: Our results confirm that epidural analgesia does not affect the rate of Cesarean delivery, while increasing the use of oxytocin augmentation, the duration of the second stage of labor and the rate of instrumental vaginal delivery.


Assuntos
Analgesia Epidural , Parto Obstétrico/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Itália/epidemiologia , Ocitocina/administração & dosagem , Gravidez , Resultado da Gravidez
20.
Lupus ; 13(9): 718-23, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15485111

RESUMO

Rheumatic autoimmune diseases have a higher prevalence in women, particularly during their childbearing age. Due to improved management, an increasing number of patients plan and carry out one or more pregnancies. Therefore, a growing interest is being paid to the possible consequences of maternal disease and associated treatment on the fetus and newborn infant. If maternal disease is characterized by the presence of IgG isotype autoantibodies, these can cross the placenta with possible antibody-mediated damage to the fetus. This is typically the case of the so called neonatal lupus erythematosus (NLE); a similar mechanism has been shown in infants of patients with immune thrombocytopenic purpura (ITP) and, less frequently, in those from mothers with antiphospholipid syndrome (APS). Indeed, this last condition is often responsible for placental, rather than neonatal, pathology. In addition, immunosuppressive and other drugs administered to the mothers during pregnancy and lactation might affect the fetal and neonatal immune system development. Finally, mothers disease and/or treatment could be related to neuropsychological alteration reported in some of their children.


Assuntos
Doenças Autoimunes/complicações , Doenças do Tecido Conjuntivo/complicações , Complicações na Gravidez , Síndrome Antifosfolipídica/complicações , Doenças Autoimunes/congênito , Doenças Autoimunes/terapia , Doenças do Tecido Conjuntivo/terapia , Feminino , Bloqueio Cardíaco/congênito , Humanos , Recém-Nascido , Lúpus Vulgar/congênito , Gravidez , Complicações na Gravidez/terapia , Púrpura Trombocitopênica Idiopática/congênito , Fatores de Risco
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