European registry of babies born to mothers with antiphospholipid syndrome
- Arsene Mekinian1,
- Eric Lachassinne2,
- Pascale Nicaise-Roland3,
- Lionel Carbillon4,
- Mario Motta5,
- Eric Vicaut6,
- Catherine Boinot7,
- Tadej Avcin8,
- Philippe Letoumelin9,
- Sara De Carolis10,
- Patrizia Rovere-Querini11,
- Marc Lambert12,
- Sophie Derenne13,
- Olivier Pourrat7,
- Jerome Stirnemann1,
- Sylvie Chollet-Martin3,
- Chiara Biasini-Rebaioli5,
- Rosanna Rovelli11,
- Andrea Lojacono5,
- Ales Ambrozic8,
- Angela Botta10,
- Amelie Benbara4,
- Fabrice Pierre7,
- Flavio Allegri5,
- Monica Nuzzo5,
- Pierre-Yves Hatron12,
- Angela Tincani5,
- Olivier Fain1,
- Marie-Helene Aurousseau14,
- Marie-Claire Boffa14
- 1Service de médecine interne, Université Paris 13, Bondy, France
- 2Service de néonatologie et pédiatrie, Université Paris 13, Bondy, France
- 3Unité Fonctionnelles d'Immunologie ‘Autoimmunité et Hypersensibilités’, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- 4Service de gynécologie-obstétrique, Université Paris 13, Bondy, France
- 5Rheumatology, Obstetrics, Neonatology and Neonatal Intensive Care Unit, Spedali Civili, University of Brescia, Brescia, Italy
- 6Service d'Epidémiologie et Biostatistiques, Hôpital Lariboisière, AP-Hôpitaux de Paris, Université Paris 7, Paris, France
- 7Service d'hématologie biologique, médecine interne, gynécologie-obstétrique, néonatologie, CHU Poitiers, Poitiers, France
- 8Pediatrics, Rheumatology, Gynecology-obstetrics, University Chidren's Hospital Ljubljana, University Medical Center, Ljubljana, Slovenia
- 9Service d'Epidémiologie et Biostatistiques, Hôpital Avicenne, AP-Hôpitaux de Paris, Bobigny, Université Paris 13, Paris, France
- 10Rheumatology, Obstetrics and Gynecology, Pediatrics, Catholic University, Rome, Italy
- 11Rheumatology, Obstetrics, and Neonatology, San Rafaele Scientific Institute, Milano, Italy
- 12Service de médecine interne, Université Lille 2, Hôpital Claude Huriez, Lille, France
- 13Service d'hématologie biologique, CHU Nantes, Nantes, France
- 14Service d'hématologie biologique, Université Paris 13, Bondy, France
- Correspondence to Arsène Mekinian, Service de Médecine Interne, Université Paris 13, AP-HP, Hôpital Jean Verdier, 93140 Bondy, France;
Contributors All authors were involved in drafting the article. OF had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of data analysis. Study conception and design: MCB, EL, MHA, LC, PNR, PL, AM, OF. Determination of APL antibodies: PNR, MHA, SCM. Acquisition of data: AM, MCB, EL, MHA, SCM, PL, LC, PNR, OF. Analysis and interpretation of data: AM, MCB, EL, EV, MHA, LC, PNR, OF Contributors who actively participated to the project and collected data in Pediatrics (P), Obstetrics (O), Rheumatology (R), Internal Medicine (IM), Hematology (H), Immunology (I): B Perrone (P), S Zatti (O), R Ottaviani (R-I), Spedali Civili and University of Brescia, Brescia, Italy. S Besnier-Di Maio (P), A Barra (I), CHU and University de Poitiers, Poitiers, France. MP De Carolis (P), S Salvi (O), Catholic University, Rome, Italy. C Giovanettoni (P) F Pasi (O), MT Castiglioni (O), MG Sabbadini (IM), San Raffaele Scientific Institute, and Vita-Salute University, Milano, Italy. M Tomsic (R), Z Novak-Antolic (0) University Medical Left, Ljubljana, Slovenia.
- Accepted 25 March 2012
- Published Online First 15 May 2012
Objectives This study aimed to describe the long-term outcome and immunological status of children born to mothers with antiphospholipid syndrome, to determine the factors responsible for childhood abnormalities, and to correlate the child's immunological profile with their mothers.
Methods A prospective follow-up of a European multicentre cohort was conducted. The follow-up consisted of clinical examination, growth data, neurodevelopmental milestones and antiphospholipid antibodies (APL) screening. Children were examined at 3, 9, 24 months and 5 years.
Results 134 children were analysed (female sex in 65 cases, birth weight 3000±500 g, height 48±3 cm). Sixteen per cent had a preterm birth (<37 weeks; n=22), and 14% weighted less than 2500 g at birth (n=19). Neonatal complications were noted in 18 cases (13%), with five infections (4%). During the 5-year follow-up, no thrombosis or systemic lupus erythematosus (SLE) was noted. Four children displayed behavioural abnormalities, which consisted of autism, hyperactive behaviour, feeding disorder with language delay and axial hypotony with psychomotor delay. At birth lupus anticoagulant was present in four (4%), anticardiolipin antibodies (ACL) IgG in 18 (16%), anti-β2 glycoprotein-I (anti-β2GPI) IgG/M in 16 (15%) and three (3%), respectively. ACL IgG and anti-β2GPI disappeared at 6 months in nine (17%) and nine (18%), whereas APL persisted in 10% of children. ACL and anti-β2GPI IgG were correlated with the same mother's antibodies before 6 months of age (p<0.05).
Conclusion Despite the presence of APL in children, thrombosis or SLE were not observed. The presence of neurodevelopmental abnormalities seems to be more important in these children, and could justify long-term follow-up.
Competing interests None.
Ethics approval This study was approved by the University Hospital of Jean Verdier Institutional Review Board and the Comité de Protection des Personnes soumises à la Recherche Biomédicale (CCPPRB, Aulnay Sous Bois, 2003).
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode