Pregnancy Requires Care Adjustment for Primary Immunodeficiency Disease

Pregnancy is achievable for patients with a range of primary immune deficiencies but requires some care adjustments, according to study results published online ahead of print in The Journal of Allergy and Clinical Immunology.

“Primary immunodeficiencies are a heterogeneous group of rare inborn immunity defects,” explained corresponding author Caroline Charlier, MD, PhD, of the Paris Centre University Hospital in France, and coauthors.  “As management has greatly improved, morbimortality is reduced in this population, while our knowledge on pregnancy unfolding and outcome remains scarce.”

To investigate pregnancy outcomes, researchers conducted a retrospective study of women from Paris in the national registry for primary immune deficiencies who reported pregnancy. Information was gleaned from medical records and questionnaires. Among the 93 patients in the study, 27 had combined immunodeficiencies, 51 had predominantly antibody deficiencies, and 15 had innate immunodeficiencies.

Among 222 pregnancies, 157 live births occurred. Four were severe preterm births. Fetal loss or pregnancy termination was associated with history of severe infection, according to the study.

Only 59% pregnancies were led with optimal anti-infective prophylaxis, which can help pregnancy outcomes, researchers reported. Severe infections occurred in 2 pregnancies, and 1 infant died during the neonatal period.

Care during pregnancy needs to be adjusted better than it has, researchers advised.

“Women with primary immunodeficiencies and a pregnancy project should be offered a multidisciplinary management (infectiological, obstetrical, and neonatal),” they wrote, “and prophylaxes must be optimized as early as possible.”

Reference:
Mallart E, Françoise U, Driessen M, et al. Pregnancy in primary immunodeficiency diseases: the PREPI study. J Allergy Clin Immunol. Published online May 18, 2023. doi:10.1016/j.jaci.2023.05.006