Maternal, foetal and child consequences of immunosuppressive drugs during pregnancy in women with organ transplant: a review.

Although pregnancy remains exceptional in women after heart, liver or lung transplant, obstetricians and nephrologists are regularly confronted with pregnancy in renal transplant recipients. National and international registries have described the epidemiology of maternal, foetal and neonatal complications, and transplantation societies have published recommendations on the monitoring of these high-risk pregnancies. In this review, we summarize the existing data on maternal and foetal complications of pregnancies in women after renal transplant, especially the management of immunosuppression. We also describe the few available data on the middle- and long-term outcomes of their children who were exposed in utero to immunosuppressive drugs.

[Pregnancies after kidney transplant: What are the consequences for the cognitive development of children?] / Grossesses après une transplantation rénale : quelles conséquences sur le développement cognitif des enfants ?

Thanks to medical progress in the field of kidney transplantation, the quality of life of women suffering from kidney failure has greatly improved in recent years. As a result, their fertility has increased significantly and pregnancies are now more frequent and safer. Kidney transplantation requires constant immunosuppressive treatment during pregnancy. These products can cross the placental barrier and their prescription is therefore subject to rigorous medical monitoring. There are many environmental factors that can affect the development of the child during pregnancy and affect its subsequent cognitive development. The possible impact of these immunosuppressive treatments on the medium- and long-term intellectual development of the children concerned is as yet little documented. Even if the available data are reassuring, the methodologies used in this work nevertheless raise questions and legitimize the development of complementary research. The aim of this review is to propose a synthesis of existing data in this field and to open up avenues for future research.

Childhood exposure to polybrominated diphenyl ethers and neurodevelopment at six years of age.

Mixtures of polybrominated diphenyl ethers (PBDEs) are present in indoor environments. Studies of the developmental effects of exposure to these chemicals in large prospective mother-child cohorts are required, with data on prenatal exposure and long-term follow-up of the children. We aimed to investigate the relationship between prenatal and childhood exposure to PBDEs and neurodevelopment at the age of six years. We determined the levels of PBDEs and other neurotoxicants in cord blood and dust collected from the homes of children for 246 families included in the PELAGIE mother-child cohort in France. We assessed two cognitive domains of the six-year-old children using the Wechsler Intelligence Scale for Children-IV. Verbal comprehension scores were lower in children from homes with higher concentrations of BDE99 (ßDetects

Severe traumatic brain injury, frontal lesions, and social aspects of language use: a study of French-speaking adults.

UNLABELLED: The purpose of this study was to gain insight into the social (pragmatic) aspects of language use by French-speaking individuals with frontal lesions following a severe traumatic brain injury. Eleven participants with traumatic brain injury performed tasks in three areas of communication: production (interview situation), comprehension (direct requests, conventional indirect requests, and hints), and metapragmatic knowledge. The results of the patients pointed out some strengths (turn-taking in production, and request comprehension, including hints and the speaker's intention) and some weaknesses (topic maintenance in production and metapragmatic knowledge). The patients' good comprehension of requests and their difficulty expressing metapragmatic knowledge suggest that they differ from controls in how they "explain the world": their knowledge of the event sequence was not based on verbally expressible knowledge about the relationship between the structural characteristics of a request utterance and those of its social production context. The pragmatic skills of persons with traumatic brain injury seem to vary across tasks: these individuals have specific strengths and weaknesses in different domains. In addition, marked interindividual differences were noted among the patients: three of them had only one weak point, topic maintenance. These interindividual differences were not systematically linked to performance on executive function tests, but lesion unilaterality (right or left) seems to help preserve patients' pragmatic and metapragmatic skills. The discussion stresses the need to take each patient's strengths and weaknesses into account in designing remediation programs. LEARNING OUTCOMES: As a result of this activity, the reader will be able to explain the social/pragmatic aspects of language in typical and atypical participants with TBI. As a result of this activity, the reader will be able to identify social/pragmatic weaknesses and strengths.

Idiom comprehension in French-speaking children and adolescents with Williams' syndrome.

This study looks at idiom comprehension by French-speaking people with Williams' syndrome (WS) and metapragmatic knowledge is examined. Idiomatic expressions are a nonliteral form of language where there is a considerable difference between what is said (literal interpretation) and what is meant (idiomatic interpretation). WS is characterized by a relatively preserved formal language, social interest and poor conversational skills. Using this framework, the present study aims to explore the comprehension of idiomatic expressions by 20 participants with WS. Participants performed a story completion task (comprehension task), and a task of metapragmatic knowledge to justify their chosen answers. WS performances were compared to typically developing children with the same verbal mental age. The main results can be summarized as follows: (1) people with WS have difficulties to understand idioms; (2) WS group seems to perform partly as typically developing children for the acquisition of metapragmatic knowledge of linguistic convention: there is a progressive increase in metapragmatic knowledge of linguistic convention as age increased. Our results indicate a delay of acquisition in idiom comprehension in Williams' syndrome.