Fetal Outcome in Anti-NMDAR Encephalitis During Pregnancy: A Systematic Review with Individual Patients Data Analysis
Abstract number :
1.232
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2021
Submission ID :
1826602
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:54 AM
Authors :
Giovanna Scorrano, MD - "G. d'Annunzio" University of Chieti-Pescara; Fedele Dono - "G. d'Annunzio" University of Chieti-Pescara; Giacomo Evangelista - "G. d'Annunzio" University of Chieti-Pescara; Stefano Consoli - "G. d'Annunzio" University of Chieti-Pescara; Marco Onofrj - "G. d'Annunzio" University of Chieti-Pescara; Francesco Chiarelli - "G. d'Annunzio" University of Chieti-Pescara
Rationale: Anti-NMDA receptor encephalitis is an autoimmune inflammatory disease which mainly affects young women, causing psychiatric and neurological manifestations. Pathogenic antibodies target extracellular domain GluN1 subunit receptor. An increasing number of reports show that anti-NMDAR encephalitis can occur also during pregnancy leading to maternal and fetal distress. In this systematic review we analyzed fetal outcome after maternal anti-NMDAR antibodies exposure during pregnancy, summarizing the available data.
Methods: We realized a systematic search of the literature to identify epidemiological, clinical, serological data of pregnant women with anti-NMDAR encephalitis and their children, analyzing pregnancy outcome. Mothers' neurologic outcomes were assessed using the modified Rankin Scale (mRS). We examined the age and neurologic symptoms of the mothers, presence of an underlying tumor, immunotherapies used during pregnancy, duration of the pregnancy, and type of delivery. Outcomes of the infants were based on clinical features, developmental abnormality, atypical behavior, the APGAR score and magnetic resonance imaging.
Results: Twenty articles were included with a total of 37 cases of Anti-NMDAR encephalitis during pregnancy. The incidence of anti-NMDAR encephalitis was higher during the first trimester of pregnancy. Ovarian teratoma was found to be the underlying cause of encephalitis in 2/37 cases. Immunotherapy was used in 20% of cases. Pregnancy outcome was positive in 80% of cases with less than 10% of newborn suffering from transient neurological or respiratory symptoms. Prematurity was found in 40% of cases. At the follow-up, children’s neurocognitive development impairment was found in less than 10% of patients. Data actually showed transplacental antibodies transition. Infants with neuropsychiatric symptoms often had anti-NMDAR antibodies serum positivity.
Conclusions: Anti-NMDAR encephalitis can be a severe comorbidity during pregnancy. Pregnancy and fetal outcome are usually positive, though children neurocognitive development impairment can occur. Long-term effects of fetus anti-NMDAR antibodies exposure have to be better explored.
Funding: Please list any funding that was received in support of this abstract.: No funding was received for this study.
Clinical Epilepsy