Autoimmune hemolytic anemia in pregnancy: a challenge for maternal and fetal follow-up.

BACKGROUND: Autoimmune hemolytic anemia (AIHA) is a rare entity during pregnancy. The fetal risk is determined primarily by the ability of autoantibodies to cross the placental barrier. Currently, the establishment of a standardized antenatal care in cases with AIHA remains as a pending issue. CASES: Firstly, we describe a case of a 17-week pregnant woman that was diagnosed with cold agglutinin mediated (C3 and IgM) AIHA. Treatment was started with prednisone, showing initial improvement, but requiring intravenous gammaglobulins at 27 weeks. During the fetal follow-up, all studies showed normal results. In the third trimester, when there was a clinic and analytic maternal improvement, an unexpected fetal death occurred. Secondly, we present a case of a 30-week pregnant woman, diagnosed with warm antibody (IgG) AIHA. Despite the ability of IgG to cross the placental barrier, the serial measurements of the Middle Cerebral Artery (MCA) peak systolic velocity were always normal and childbirth occurred at term without any adverse perinatal outcome. CONCLUSION: During pregnancy, identification of the type antibodies in AIHA is crucial to estimate the potential maternal and fetal risks and to establish the follow-up. The interaction of the complement cascade with the coagulation cascade could be an explanation for a perinatal adverse outcome despite the inability of the IgM to cross the placental barrier.

A common gene variant in STK11 is associated with metabolic risk markers and diabetes during gestation.

OBJECTIVE: To assess whether the common rs8111699 (C528G) variant in STK11 is related to metabolic risk markers in pregnant women and to gestational diabetes mellitus (GDM). DESIGN: Cross-sectional study. SETTING: Hospital. PATIENT(S): A total of 561 pregnant women: 318 without and 243 with GDM (National Diabetes Data Group criteria). INTERVENTION(S): None. MAIN OUTCOME MEASURES(S): rs8111699 variant in STK11 (Taqman technology). Fasting glucose, insulin (homeostatic model assessment of insulin resistance and ß-cell function [HOMA-IR and -ß]) and C-peptide assessed at 24-28 weeks' gestation. RESULT(S): In non-GDM women, the G allele in rs8111699 was associated with lower HOMA-IR (CC: 1.3 ± 0.1 mIU/L; GG: 0.9 ± 0.1 mIU/L) and HOMA-ß (CC: 165 ± 20 mIU/L; GG: 118 ± 10 mIU/L). In GDM women, the G allele was related to lower body mass index (BMI; CC: 27.9 ± 1.0 kg/m(2); GG: 24.5 ± 0.6 kg/m(2)) and C-peptide (CC: 2.3 ± 0.1 ng/mL; GG: 1.6 ± 0.1 ng/mL). The GG genotype was less frequently observed in GDM women (18% vs. 26%), particularly in heavier GDM women (BMI > median: 14% vs. 28%). CONCLUSION(S): In pregnant women, the G allele for the rs8111699 variant in STK11 is associated with a more favorable metabolic phenotype and may protect against the development of GDM, particularly in heavier women.