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Published in: Journal of Clinical Immunology 6/2015

01-08-2015 | ORIGINAL RESEARCH

Pregnancy Outcome in Patients with Common Variable Immunodeficiency

Authors: Pavlina Kralickova, Barbora Kurecova, Ctirad Andrys, Irena Krcmova, Dalibor Jilek, Marcela Vlkova, Jiri Litzman

Published in: Journal of Clinical Immunology | Issue 6/2015

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Abstract

Purpose

The aim of our retrospective study was to clarify fertility, pregnancy complications and outcomes in common variable immunodeficiency (CVID) females.

Methods

Retrospective data were obtained from three Czech referral centres. The data were compared with data obtained from the Czech National Registry of Reproduction Health.

Results

Our cohort of patients comprised 54 women with 115 pregnancies; 88 pregnancies in 50 females were finished with live births (77 %). In only 8 women (15 %) was the diagnosis of CVID established before the first pregnancy. Replacement immunoglobulin therapy was performed in 10 patients without any moderate or severe adverse effects. Compared with the Czech population, the CVID patients suffered significantly more frequently from the threat of preterm labour (p < 0.0001), vaginal bleeding (p = 0.0001), eclampsia/preeclampsia (p = 0.009) and a higher number of stillbirths (p < 0.0001). Furthermore, the frequency of babies with low birth weight (less than 2500 g) born to the CVID patients was increased compared with the normal population (p < 0.0001). Serum IgG, IgA and IgM determination was done in 57 children of 50 mothers showing 13 cases of IgA deficiency (23 %). There was no significant difference among the non-symptomatic, symptomatic untreated and symptomatic treated females in any of the determined gynaecological complications. The number of unsuccessful pregnancies was higher in the symptomatic untreated women.

Conclusions

Fertility in CVID patients is not decreased, and their pregnancies could be considered more risky compared with those of the general population.
Literature
1.
go back to reference Conley ME, Notarangelo LD, Etzioni A. Diagnostic criteria for primary immunodeficiencies. Representing PAGID (Pan-American Group for Immunodeficiency) and ESID (European Society for Immunodeficiencies). Clin Immunol. 1999;93:190–7.CrossRef Conley ME, Notarangelo LD, Etzioni A. Diagnostic criteria for primary immunodeficiencies. Representing PAGID (Pan-American Group for Immunodeficiency) and ESID (European Society for Immunodeficiencies). Clin Immunol. 1999;93:190–7.CrossRef
2.
go back to reference Resnick ES, Moshier EL, Godbold JH, Cunningham-Rundles C. Morbidity and mortality in common variable immune deficiency over 4 decades. Blood. 2012;119:1650–7.CrossRef Resnick ES, Moshier EL, Godbold JH, Cunningham-Rundles C. Morbidity and mortality in common variable immune deficiency over 4 decades. Blood. 2012;119:1650–7.CrossRef
3.
go back to reference Quinti I, Soresina A, Spadaro G, Martino S, Donnanno S, Agostini C, et al. Long-term follow-up and outcome of a large cohort of patients with common variable immunodeficiency. J Clin Immunol. 2007;27:308–16.CrossRef Quinti I, Soresina A, Spadaro G, Martino S, Donnanno S, Agostini C, et al. Long-term follow-up and outcome of a large cohort of patients with common variable immunodeficiency. J Clin Immunol. 2007;27:308–16.CrossRef
4.
go back to reference Shalev E, Ben-Ami M, Peleg D. Common variable hypogammaglobulinemia in pregnancy. Br J Obstet Gynaecol. 1993;100:1138–40.CrossRef Shalev E, Ben-Ami M, Peleg D. Common variable hypogammaglobulinemia in pregnancy. Br J Obstet Gynaecol. 1993;100:1138–40.CrossRef
5.
go back to reference Gundlapalli AV, Scalchunes C, Boyle M, Hill HR. Fertility, pregnancies and outcomes reported by females with common variable immune deficiency and hypogammaglobulinemia: results from an internet-based survey. J Clin Immunol. 2015;35:125–34.CrossRef Gundlapalli AV, Scalchunes C, Boyle M, Hill HR. Fertility, pregnancies and outcomes reported by females with common variable immune deficiency and hypogammaglobulinemia: results from an internet-based survey. J Clin Immunol. 2015;35:125–34.CrossRef
8.
go back to reference Fencl F, Malina M, Stara V, Zieg J, Mixova D, Seeman T, et al. Discordant expression of a new WT1 gene mutation in a family with monozygotic twins presenting with congenital nephrotic syndrome. Eur J Pediatr. 2012;171:121–4.CrossRef Fencl F, Malina M, Stara V, Zieg J, Mixova D, Seeman T, et al. Discordant expression of a new WT1 gene mutation in a family with monozygotic twins presenting with congenital nephrotic syndrome. Eur J Pediatr. 2012;171:121–4.CrossRef
9.
go back to reference Laursen HB, Christensen MF. Immunoglobulins in normal infant born of severe hypo-gamma-globulinaemic mother. Arch Dis Child. 1973;48:646–8.CrossRef Laursen HB, Christensen MF. Immunoglobulins in normal infant born of severe hypo-gamma-globulinaemic mother. Arch Dis Child. 1973;48:646–8.CrossRef
10.
go back to reference Williams PE, Leen CL, Heppleston AD, Yap PL. IgG replacement therapy for primary hypogammaglobulinaemia during pregnancy: report of 9 pregnancies in 4 patients. Blut. 1990;60:198–201.CrossRef Williams PE, Leen CL, Heppleston AD, Yap PL. IgG replacement therapy for primary hypogammaglobulinaemia during pregnancy: report of 9 pregnancies in 4 patients. Blut. 1990;60:198–201.CrossRef
11.
go back to reference Zak SJ, Good RA. Immunochemical studies of human serum gamma globulins. J Clin Invest. 1959;38:579–86.CrossRef Zak SJ, Good RA. Immunochemical studies of human serum gamma globulins. J Clin Invest. 1959;38:579–86.CrossRef
12.
go back to reference Bridges RA, Condie RM, Zak SJ, Good RA. The morphologic basis of antibody formation development during the neonatal period. J Lab Clin Med. 1959;53:331–57.PubMed Bridges RA, Condie RM, Zak SJ, Good RA. The morphologic basis of antibody formation development during the neonatal period. J Lab Clin Med. 1959;53:331–57.PubMed
13.
go back to reference Holland NH, Holland P. Immunological maturation in an infant of an agammaglobulinaemic mother. Lancet. 1966;2:1152–5.CrossRef Holland NH, Holland P. Immunological maturation in an infant of an agammaglobulinaemic mother. Lancet. 1966;2:1152–5.CrossRef
14.
go back to reference Berger M, Cupps TR, Fauci AS. High-dose immunoglobulin replacement therapy by slow subcutaneous infusion during pregnancy. JAMA. 1982;247:2824–5.CrossRef Berger M, Cupps TR, Fauci AS. High-dose immunoglobulin replacement therapy by slow subcutaneous infusion during pregnancy. JAMA. 1982;247:2824–5.CrossRef
15.
go back to reference Malek A, Sager R, Kuhn P, Nicolaides KH, Schneider H. Evolution of maternofetal transport of immunoglobulins during human pregnancy. Am J Reprod Immunol. 1996;36:248–55.CrossRef Malek A, Sager R, Kuhn P, Nicolaides KH, Schneider H. Evolution of maternofetal transport of immunoglobulins during human pregnancy. Am J Reprod Immunol. 1996;36:248–55.CrossRef
16.
go back to reference Kohler PF, Farr RS. Elevation of cord over maternal IgG immunoglobulin: evidence for an active placental IgG transport. Nature. 1966;210:1070–1.CrossRef Kohler PF, Farr RS. Elevation of cord over maternal IgG immunoglobulin: evidence for an active placental IgG transport. Nature. 1966;210:1070–1.CrossRef
17.
go back to reference Pitcher-Wilmott RW, Hindocha P, Wood CB. The placental transfer of IgG subclasses in human pregnancy. Clin Exp Immunol. 1980;41:303–8.PubMedPubMedCentral Pitcher-Wilmott RW, Hindocha P, Wood CB. The placental transfer of IgG subclasses in human pregnancy. Clin Exp Immunol. 1980;41:303–8.PubMedPubMedCentral
18.
go back to reference Gardulf A, Andersson E, Lindqvist M, Hansen S, Gustafson R. Rapid subcutaneous IgG replacement therapy at home for pregnant immunodeficient women. J Clin Immunol. 2001;21:150–4.CrossRef Gardulf A, Andersson E, Lindqvist M, Hansen S, Gustafson R. Rapid subcutaneous IgG replacement therapy at home for pregnant immunodeficient women. J Clin Immunol. 2001;21:150–4.CrossRef
19.
go back to reference Funakoshi N, Ohno T, Kanoh T, Uchino H, Miyake T, Oda T, et al. Agammaglobulinemia in a pregnant woman. Tohoku J Exp Med. 1986;149:359–65.CrossRef Funakoshi N, Ohno T, Kanoh T, Uchino H, Miyake T, Oda T, et al. Agammaglobulinemia in a pregnant woman. Tohoku J Exp Med. 1986;149:359–65.CrossRef
20.
go back to reference Madsen DL, Catanzarite VA, Varela-Gittings F. Common variable hypogammaglobulinemia in pregnancy: treatment with high-dose immunoglobulin infusions. Am J Hematol. 1986;21:327–9.CrossRef Madsen DL, Catanzarite VA, Varela-Gittings F. Common variable hypogammaglobulinemia in pregnancy: treatment with high-dose immunoglobulin infusions. Am J Hematol. 1986;21:327–9.CrossRef
21.
go back to reference Osada H, Morikawa Y, Nishiwaki T, Sekiya S. Intravenous immunoglobulin replacement therapy for common variable immunodeficiency during pregnancy. Arch Gynecol Obstet. 1996;258:155–9.CrossRef Osada H, Morikawa Y, Nishiwaki T, Sekiya S. Intravenous immunoglobulin replacement therapy for common variable immunodeficiency during pregnancy. Arch Gynecol Obstet. 1996;258:155–9.CrossRef
22.
go back to reference Sorensen RU, Tomford JW, Gyves MT, Judge NE, Polmar SH. Use of intravenous immune globulin in pregnant women with common variable hypogammaglobulinemia. Am J Med. 1984;76:73–7.CrossRef Sorensen RU, Tomford JW, Gyves MT, Judge NE, Polmar SH. Use of intravenous immune globulin in pregnant women with common variable hypogammaglobulinemia. Am J Med. 1984;76:73–7.CrossRef
23.
go back to reference Brinker KA, Silk HJ. Common variable immune deficiency and treatment with intravenous immunoglobulin during pregnancy. Ann Allergy Asthma Immunol. 2012;108:464–5.CrossRef Brinker KA, Silk HJ. Common variable immune deficiency and treatment with intravenous immunoglobulin during pregnancy. Ann Allergy Asthma Immunol. 2012;108:464–5.CrossRef
24.
go back to reference Danieli MB, Moretti R, Pettinari L, Gambini S. Management of a pregnant woman with common variable immunodeficiency and previous reactions to intravenous IgG administration. BMJ Case Rep. 2012. doi:10.1136/bcr-2012-007594. Danieli MB, Moretti R, Pettinari L, Gambini S. Management of a pregnant woman with common variable immunodeficiency and previous reactions to intravenous IgG administration. BMJ Case Rep. 2012. doi:10.​1136/​bcr-2012-007594.
25.
go back to reference Schaffer FM, Newton MDIA. Intravenous gamma globulin administration to common variable immunodeficient women during pregnancy: case report and review of literature. J Perinatol. 1994;14:114–7.PubMed Schaffer FM, Newton MDIA. Intravenous gamma globulin administration to common variable immunodeficient women during pregnancy: case report and review of literature. J Perinatol. 1994;14:114–7.PubMed
26.
go back to reference Vorechovsky I, Webster AD, Plebani A, Hammarstrom L. Genetic linkage of IgA deficiency to the major histocompatibility complex: evidence for allele segregation distortion, parent-of-origin penetrance differences, and the role of anti-IgA antibodies in disease predisposition. Am J Hum Genet. 1999;64:1096–109.CrossRef Vorechovsky I, Webster AD, Plebani A, Hammarstrom L. Genetic linkage of IgA deficiency to the major histocompatibility complex: evidence for allele segregation distortion, parent-of-origin penetrance differences, and the role of anti-IgA antibodies in disease predisposition. Am J Hum Genet. 1999;64:1096–109.CrossRef
27.
go back to reference Litzman J, Sevcikova I, Stikarovska D, Pikulova Z, Pazdirkova A, Lokaj J. IgA deficiency in Czech healthy individuals and selected patient groups. Int Arch Allergy Immunol. 2000;123:177–80.CrossRef Litzman J, Sevcikova I, Stikarovska D, Pikulova Z, Pazdirkova A, Lokaj J. IgA deficiency in Czech healthy individuals and selected patient groups. Int Arch Allergy Immunol. 2000;123:177–80.CrossRef
Metadata
Title
Pregnancy Outcome in Patients with Common Variable Immunodeficiency
Authors
Pavlina Kralickova
Barbora Kurecova
Ctirad Andrys
Irena Krcmova
Dalibor Jilek
Marcela Vlkova
Jiri Litzman
Publication date
01-08-2015
Publisher
Springer US
Published in
Journal of Clinical Immunology / Issue 6/2015
Print ISSN: 0271-9142
Electronic ISSN: 1573-2592
DOI
https://doi.org/10.1007/s10875-015-0188-7

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