Sara De Carolis, Italy
Fondazione Policlinico Gemelli IRCCS Obstetrics and GynaecologyPresenter of 3 Presentations
SEROPREVALENCE OF PARVOVIRUS B19 AND EPSTEIN-BARR VIRUS IN PREGNANT WOMEN WITH AUTOIMMUNE DISEASES AND IN HEALTHY PREGNANT WOMEN
Abstract
Background and Aims
The relationship between autoimmune diseases and infections is an interesting and complex issue. Infections may be trigger factors of the onset or exacerbation of autoimmune diseases and could also modulate the disease’s clinical presentation. The seroprevalence for parvovirus B19 and Epstein-Barr virus is reported with different results.
Methods
We evaluated the seroprevalence for PVB19 and EBV in 280 pregnant women with autoimmune diseases and in 207 healthy pregnant women. Among women with autoimmune diseases 89 were affected by Antiphospholipid Syndrome, defined as APS group.
Results
The prevalence of IgG positive for EBV (EBNA and VCA) and PV B19 resulted higher in autoimmune diseases group and in APS group in comparison with that of control group. The prevalence of positive PV B19 IgG in the autoimmune diseases group was greater than in the control group (63.6% and 52.6%, respectively; p-value 0.058) but was statistically significantly higher only in the APS group than in the control group (76.7% and 52.6%, respectively, with a p-value 0.004).
Conclusions
Our results support the hypothesis that PV B19 is an important environmental factor involved in the onset of autoimmune diseases, particularly in women affected by APS.
COMPLEMENTEMIA IN PREGNANCIES WITH ANTIPHOSPHOLIPID SYNDROME
Abstract
Background and Aims
Prognosis of pregnancies in women with antiphospholipid syndrome has dramatically improved over the past two decades using conventional treatment with low molecular weight heparin and low-dose aspirin. However, despite this regimen, 10–15% of antiphospholipid syndrome patients experience pregnancy losses.
Methods
Several studies have been performed in order to identify risk factors predictive of complications. Thrombosis has been generally accepted as the key pathogenetic mechanism underlying pregnancy morbidity. However, the thrombogenic state alone is not able to explain all the different mechanisms leading to pregnancy failure.
Results
Low complement levels (C3 and C4) are associated with poor pregnancy outcome in women with antiphospholipid syndrome in different studies. In fact, emerging evidence shows that complement pathway could play an important role in mediating clinical events in antiphospholipid syndrome. However, the exact mechanism through which complement mediates antiphospholipid syndrome complications remains unknown.
Conclusions
Hypocomplementemia could be indicated as an early predictor of adverse pregnancy outcome, available at the beginning of pregnancy for starting, if necessary, additional treatment to conventional therapy. However, future studies need to better understand the impact of low complement level on antiphospholipid syndrome pregnancy outcome.
LUPUS ANTICOAGULANT REMISSION AFTER GLUTEN-FREE DIET IN A COELIAC PREGNANT WOMAN
Abstract
Background and Aims
Coeliac disease is an immune-mediated small bowel disorder. The only treatment for coeliac disease is strict and life-long adherence to a gluten-free diet. The association between coeliac disease and autoimmune conditions, reproductive abnormalities and obstetrical complications is well reported in the literature. We report an intriguing case of successful pregnancy and lupus anticoagulant remission after gluten-free diet in a woman affected by coeliac disease and antiphospholipid syndrome.
Methods
We observed a case of a 37-year-old woman with Antiphospholipid Syndrome (APS) diagnosed after a fetal loss at the 17th week of pregnancy with positive lupus anticoagulant (LA), confirmed after 12 weeks. The coeliac disease tests also resulted positive, and the diagnosis of coeliac disease was confirmed by duodenal biopsy, so the patient started a gluten-free dietary regimen. After eight months of strict gluten-free diet, the patient was again pregnant. A standard therapy with low dose aspirin and enoxaparin sodium 4000 IU/day was started.
Results
At the beginning of the pregnancy, both LA test and serological markers for coeliac disease were repeatedly negative. At 40 weeks of gestation, a healthy baby weighing 2730 g (12th percentile) was delivered and discharged on the second day of life in good condition.
Conclusions
Gluten-free diet, by abolishing the gluten trigger, could positively influence the patient’s immunological status. In fact, both the negative coeliac disease markers and the negative LA results might reflect the beneficial effect of a gluten-free regimen also on the pregnancy outcome.