scholarly journals Effect of in utero hydroxychloroquine exposure on the development of cutaneous neonatal lupus erythematosus

2018 ◽  
Vol 77 (12) ◽  
pp. 1742-1749 ◽  
Author(s):  
Julie Barsalou ◽  
Nathalie Costedoat-Chalumeau ◽  
Adey Berhanu ◽  
Cesar Fors-Nieves ◽  
Ummara Shah ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Secondary Analysis ◽  
Female Gender ◽  
In Utero ◽  
In Utero Exposure ◽  
Neonatal Lupus ◽  
Increased Risk ◽  
Rheumatological Disease ◽  
The Difference ◽  
Reduced Risk

ObjectiveCutaneous neonatal lupus (cNL) occurs in possibly 5%–16% of anti-Ro±anti-La antibody–exposed infants. Data suggest in utero exposure to hydroxychloroquine (HCQ) may prevent cardiac NL. The aim was to assess whether in utero exposure to HCQ decreases the risk of cNL and/or delays onset.MethodsA multicentre case–control study was performed with 122 cNL cases and 434 controls born to women with a rheumatological disease who had documentation of maternal anti-Ro±anti-La antibodies at pregnancy and confirmation of medication use and the child’s outcome. A secondary analysis was performed on 262 cNL cases, irrespective of maternal diagnosis, to determine if HCQ delayed time to cNL onset.ResultsTwenty (16%) cNL cases were exposed to HCQ compared with 146 (34%) controls (OR 0.4 (95% CI 0.2 to 0.6); p<0.01). Exposure to HCQ was associated with a reduced risk of cNL; exposure to anti-La antibody and female gender were associated with an increased risk of cNL. Exposure to HCQ remained significantly associated with a reduced cNL risk in the analyses limited to mothers with systemic lupus erythematosus and those who developed rash ≤1 month. When analysing all 262 cNL cases, HCQ-exposed infants were older (6.0 (95% CI 5.7 to 6.3) weeks) at cNL onset versus HCQ-non-exposed infants (4.4 (95% CI 3.9 to 5.0) weeks), but the difference was not statistically significant (p=0.21).ConclusionExposure to HCQ was associated with a reduced risk of cNL. Among cNL cases, those exposed to HCQ tend to have later onset of rash. Both findings suggest a protective effect of HCQ on cNL.

scholarly journals Association between confirmed congenital Zika infection at birth and outcomes up to 3 years of life

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Najeh Hcini ◽  
Yaovi Kugbe ◽  
Zo Hasina Linah Rafalimanana ◽  
Véronique Lambert ◽  
Meredith Mathieu ◽  
...  
Keyword(s):  
Neurological Impairment ◽  
In Utero ◽  
In Utero Exposure ◽  
Zikv Infection ◽  
Neurodevelopmental Delay ◽  
Systematic Testing ◽  
Brain Anomalies ◽  
Increased Risk ◽  
Structural Brain

AbstractLittle is known about the long-term neurological development of children diagnosed with congenital Zika infection at birth. Here, we report the imaging and clinical outcomes up to three years of life of a cohort of 129 children exposed to Zika virus in utero. Eighteen of them (14%) had a laboratory confirmed congenital Zika infection at birth. Infected neonates have a higher risk of adverse neonatal and early infantile outcomes (death, structural brain anomalies or neurologic symptoms) than those who tested negative: 8/18 (44%) vs 4/111 (4%), aRR 10.1 [3.5–29.0]. Neurological impairment, neurosensory alterations or delays in motor acquisition are more common in infants with a congenital Zika infection at birth: 6/15 (40%) vs 5/96 (5%), aRR 6.7 [2.2–20.0]. Finally, infected children also have an increased risk of subspecialty referral for suspected neurodevelopmental delay by three years of life: 7/11 (64%) vs 7/51 (14%), aRR 4.4 [1.9–10.1]. Infected infants without structural brain anomalies also appear to have an increased risk, although to a lesser extent, of neurological abnormalities. It seems paramount to offer systematic testing for congenital ZIKV infection in cases of in utero exposure and adapt counseling based on these results.

scholarly journals AB0423 NEUROPSYCHIATRIC OUTCOME OF CHILDREN BORN TO WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) WOMEN AND EXPOSED IN UTERO TO AZATHIOPRINE: A CASE-CONTROL STUDY.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1511.2-1511
Author(s):  
M. G. Lazzaroni ◽  
F. Crisafulli ◽  
I. Debeni ◽  
C. Nalli ◽  
L. Andreoli ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Renal Involvement ◽  
In Utero ◽  
Learning Disorders ◽  
Control Group ◽  
In Utero Exposure ◽  
Term Outcome ◽  
Similar Frequency ◽  
Long Term Outcome

Background:A possible increase in neurodevelopmental (ND) and learning disorders (LD) in the offspring of mothers affected by SLE have been suggested in some studies, along with the identification of different possible risk factors. Azathioprine (AZA) is commonly used during pregnancy, based on its non-teratogenicity and extended experience in women with different diseases. However, a few small studies suggested an association between in utero exposure to AZA and possible increased frequency of ND/LD in children, indirectly derived from increased request of supportive educational services.Objectives:To evaluate the medium-long term outcome in terms of ND/LD in children of school age (≥6 years) born to SLE women treated with AZA during pregnancy, as compared to that of children born to SLE mothers not treated with AZA during pregnancy.Methods:Data from our Pregnancy Clinic registry were collected for prospectively followed pregnancies of SLE women treated with AZA (cases) and compared to pregnancies of SLE women not treated with AZA (controls), that were matched for age at pregnancy, presence of renal involvement and aPL positivity. SLE patients (cases and controls) were interviewed by phone to collect data about their children, focusing on the presence of ND/LD certified by Neuropsychiatrists.Results:Data were collected for 14 SLE mothers in the AZA group and 31 in the control group, with similar age at pregnancy (30.3±5.21 vs 31.4±4.70 years, p:0.45) and frequency of renal involvement (50.0% vs 44.1%, p:0.77), aPL positivity (33.3% vs 29.4%, p:0.76) and anti-Ro/SSA positivity (27.8% vs. 26.5%, p:0.55). A SLE flare during pregnancy was more frequently recorded in the AZA group (27.8% vs. 2.94%, p:0.02). Other medications included HCQ (55.6% vs. 70.6%, p:0.36) and corticosteroids (100% vs 79.4%, p:0.08).We collected data for 18 children in the AZA group and 34 children in the control group, that had a similar mean age at the time of the interview (12.7±4.80 vs. 12.9±5.61 years, p:0.91). The two groups had also similar gestational age (37.4±2.20 weeks vs. 38.0±1.29 weeks, p:0.23), birth weight (3003±433 g vs 3011±453 g, p:0.95) and rate of male sex (61.1% vs 44.1%, p:0.38).We recorded similar frequency of ND/LD in the two groups. In particular, a ND was present in 2/18 (11.1%) of children exposed to AZA vs. 2/34 (5.88%) in the control group (p:0.60). A LD was present in 1/18 cases (5.56%) and 6/34 controls (17.6%) (p:0.40).Conclusion:The medium-long term outcome of children born to SLE mothers in the whole cohort was characterized by the presence of ND in 4/54 (7.69%) and LD in 7/52 (13.5%). ND/LD do not seem to be related to in utero exposure to AZA.Disclosure of Interests:None declared

scholarly journals In utero exposure to ritodrine during pregnancy and risk of autism in their offspring until 8 years of age

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jungsoo Chae ◽  
Geum Joon Cho ◽  
Min-Jeong Oh ◽  
KeonVin Park ◽  
Sung Won Han ◽  
...  
Keyword(s):  
National Health ◽  
Screening Program ◽  
Hazard Analysis ◽  
Population Based ◽  
In Utero ◽  
National Database ◽  
Rank Test ◽  
In Utero Exposure ◽  
Exposure Group ◽  
Increased Risk

AbstractBeta-2 adrenergic receptor (B2AR) agonists, used as asthma treatments and tocolytics during pregnancy, have recently been reported to be associated with autism in their offspring. However, the particular link between autism and ritodrine, a common type of B2AR agonist used solely as tocolytics, has never been substantiated with any nationwide database. Thus, we aimed to examine the association between in utero exposure of ritodrine and the risk of autism in their offspring using a national database. This population-based cohort study was conducted by merging the Korea National Health Insurance claims database and National Health Screening Program for Infants and Children database. These databases included all women who had delivered singleton between January 2007 and December 2008 in Korea. Out of the total 770,016 mothers, 30,959 (4.02%) were exposed to ritodrine during pregnancy, and 5583 (0.73%) of their children were identified as having autism, defined until 8 years of age. According to our analysis, the overall cumulative incidence of autism up to 8 years was 1.37% in ritodrine exposure group and 0.70% in ritodrine non-exposure group (p < 0.05, log-rank test). By Cox proportional hazard analysis, use of ritodrine in preterm birth was associated with significantly higher hazard of autism [adjusted hazard ratio: 1.23, 95% CI 1.04–1.47], after adjusting for confounding variables including maternal age, parity, cesarean section, preterm labor, steroid use, birth weight, gender, and preeclampsia. Thus, in utero exposure to ritodrine was associated with an increased risk of autism in their offspring.

scholarly journals In-Utero Exposure to Cigarette Smoking on Child Long-Term Risk of Obesity: Concordance of Self-Report, Maternal and Cord Blood Biomarkers

2021 ◽  
Author(s):  
Wenpin Hou ◽  
Mingyu Zhang ◽  
Yuelong Ji ◽  
Xiumei Hong ◽  
Guoying Wang ◽  
...  
Keyword(s):  
Cigarette Smoking ◽  
In Utero ◽  
Self Report ◽  
In Utero Exposure ◽  
Cord Plasma ◽  
Smoking Exposure ◽  
Increased Risk ◽  
Logistic Regressions ◽  
Reported Data

Most studies on the association of in utero exposure to cigarette smoking and childhood overweight or obesity (OWO) were based on maternal self-reported smoking data and few were based on objective biomarkers. In this study, we evaluated the associations between self-reported and biomarkers of in utero exposure to cigarette smoking with risk of childhood OWO. We analyzed data from 2351 mother-child pairs in the Boston Birth Cohort, a US low-income minority cohort that enrolled children at birth and followed prospectively up to age 18 years. In utero smoking exposure was measured by maternal self-report and by maternal and cord plasma cotinine and hydroxycotinine metabolites. We assessed the individual and joint associations of each smoking exposure measure and maternal OWO with childhood OWO using multinomial logistic regressions. We used nested logistic regressions to investigate the childhood OWO prediction performance when adding maternal and cord plasma biomarkers as input covariates on top of self-reported data. Our results demonstrated that in utero cigarette smoking exposure defined by self-report and by maternal or cord metabolites were consistently associated with increased risk of long-term child OWO. Adding maternal and cord plasma biomarker information to self-reported data improved the prediction accuracy of long-term child OWO risk.

Prenatal predisposing factors associated with neonatal lupus erythematosus

Lupus ◽  
2022 ◽  
pp. 096120332110664
Author(s):  
Sanitra Anuwutnavin ◽  
Varisa Chuenchitkultavorn ◽  
Rattanavalai Nitiyarom ◽  
Thanapa Rekhawasin ◽  
Supaluck Kanjanauthai ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Lupus Erythematosus ◽  
Protective Factor ◽  
Predisposing Factors ◽  
Neonatal Lupus ◽  
Retrospective Case ◽  
Female Fetus ◽  
Neonatal Lupus Erythematosus ◽  
Increased Risk ◽  
Female Baby

Objectives To identify the prenatal predisposing factors related to neonatal lupus erythematosus (NLE). Materials and Methods A retrospective case-control study was made of 131 pregnant women with positive anti-Ro or anti-La autoantibodies and known neonatal outcomes between January 2002 and December 2019 at Siriraj Hospital, Bangkok, Thailand. There were 101 unaffected neonates and 30 NLE cases confirmed postnatally. Demographic and clinical data of the mothers and neonates with and without NLE were statistically compared. Results NLE was diagnosed in 30 out of 131 cases. A multivariate analysis identified the following significant factors for NLE: maternal anti-La antibodies (odds ratio (OR), 3.591; p = 0.030); and maternal treatment with either hydroxychloroquine (OR, 0.082; p = 0.001) or prednisolone (OR, 0.136; p = 0.017). Of the significant variables examined in the multivariate analysis models, high levels of maternal anti-La antibodies were found to be the strongest predictor of noncardiac NLE (OR, 4.558; p = 0.032), while a female baby was significantly higher in pregnancies complicated by cardiac NLE (OR, 5.374; p = 0.046). Hydroxychloroquine still provided a protective effect for both cardiac and noncardiac NLE ( p = 0.039 and 0.032, respectively). Conclusions The maternal anti-La antibodies were a beneficial predictor for NLE, especially as their high titers were influentially associated with noncardiac features. A female fetus seemed to present an increased risk for developing a congenital heart block. Nevertheless, the treatment with hydroxychloroquine during the pregnancies demonstrated a potentially protective factor against both cardiac and noncardiac manifestations.

A-40 The Neurocognitive and Behavioral Profile of an Adolescent with in-Utero Exposure to Alcohol

2021 ◽  
Vol 36 (6) ◽  
pp. 1081-1081
Author(s):  
Alphonso Smith ◽  
Courtney Norris
Keyword(s):  
Neuropsychological Assessment ◽  
Adaptive Functioning ◽  
Alcohol Exposure ◽  
In Utero ◽  
Attention Problems ◽  
In Utero Exposure ◽  
Social Emotional ◽  
Neuropsychological Profile ◽  
Increased Risk

Abstract Objective Prenatal alcohol exposure can result in altered brain development that has detrimental effects on children and put them at increased risk for cognitive impairment, sensorimotor deficits, attention problems, behavioral issues, and social–emotional difficulties. Further, adolescents with neurodevelopmental disorders associated with in-utero exposure to alcohol require targeted academic and psychosocial support as they transition into adulthood which emphasizes the need for neuropsychological assessment. Method This case study presents on the neuropsychological profile of a 17-year-old male in the 11th grade who was exposed to alcohol in-utero and was diagnosed with fetal alcohol effects as a young child by his primary care physician. Results Neuropsychological testing revealed a broad range of impairments which included deficits in intellectual functioning (mild disability), adaptive functioning, language, academic achievement, attention, executive functioning, memory, fine/visuomotor skills, and social–emotional functioning. Conclusions Recommendations were made to modify his special education goals by targeting his functional academic skills, adaptive functioning, communication skills, and post-high school transition planning. Recommendations for behavioral interventions were given to his referring psychotherapist to aid in treatment planning. Information on vocational counseling and financial support for individuals with developmental disabilities were provided to the patient’s guardian as well. This case study illustrates the long-lasting neurocognitive and behavioral effects associated with in-utero alcohol exposure and the need for neuropsychological assessment during adolescence in order to reduce secondary issues (e.g., school problems, lack of mental health support, unemployment, and financial hardship) that can occur as these individuals move into adulthood.

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