The Influence of Treatment of Inflammatory Arthritis During Pregnancy on the Long-Term Children’s Outcome
The management of reproductive issues in women with inflammatory arthritis has greatly changed over decades. In the 1980–1990s, women with refractory forms of arthritis were either not able to get pregnant or did choose not to get pregnant because of their disabling disease. Hence, the traditional b...
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| Format: | Article |
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Frontiers Media S.A.
2021-03-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2021.626258/full |
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| author | Cecilia Nalli Jessica Galli Daniele Lini Daniele Lini Angela Merlini Silvia Piantoni Silvia Piantoni Maria Grazia Lazzaroni Maria Grazia Lazzaroni Victoria Bitsadze Jamilya Khizroeva Sonia Zatti Laura Andreoli Laura Andreoli Elisa Fazzi Franco Franceschini Franco Franceschini Alexander Makatsariya Yehuda Shoenfeld Yehuda Shoenfeld Yehuda Shoenfeld Angela Tincani Angela Tincani Angela Tincani |
| author_facet | Cecilia Nalli Jessica Galli Daniele Lini Daniele Lini Angela Merlini Silvia Piantoni Silvia Piantoni Maria Grazia Lazzaroni Maria Grazia Lazzaroni Victoria Bitsadze Jamilya Khizroeva Sonia Zatti Laura Andreoli Laura Andreoli Elisa Fazzi Franco Franceschini Franco Franceschini Alexander Makatsariya Yehuda Shoenfeld Yehuda Shoenfeld Yehuda Shoenfeld Angela Tincani Angela Tincani Angela Tincani |
| author_sort | Cecilia Nalli |
| collection | DOAJ |
| description | The management of reproductive issues in women with inflammatory arthritis has greatly changed over decades. In the 1980–1990s, women with refractory forms of arthritis were either not able to get pregnant or did choose not to get pregnant because of their disabling disease. Hence, the traditional belief that pregnancy can induce a remission of arthritis. The availability of biologic agents has allowed a good control of aggressive forms of arthritis. The main topic of discussion during preconception counselling is the use of drugs during pregnancy and breastfeeding. Physicians are now supported by international recommendations released by the European League Against Rheumatism and the American College of Rheumatology, but still they must face with cultural reluctance in accepting that a pregnant woman can take medications. Patient-physician communication should be centered on the message that active maternal disease during pregnancy is detrimental to fetal health. Keeping maternal disease under control with drugs which are not harmful to the fetus is the best way to ensure the best possible outcome for both the mother and the baby. However, there might be concerns about the influence of the in utero exposure to medications on the newborn’s health conditions. Particularly, studies suggesting an increased risk of autism-spectrum-disorders in children born to women with rheumatoid arthritis has raised questions about neuropsychological impairment in the offspring of women with chronic arthritis. As a multidisciplinary group of rheumatologists and child neuropsychiatrists, we conducted a study on 16 women with chronic forms of arthritis whose diagnosis was determined before pregnancy and their 18 school-age children. The children underwent a complete neurological examination and validated tests/questionnaires. Behavioral aspects of somatization and anxiety/depression (internalizing problem) or an “adult profile” were found in nearly one third of children. Children at a high risk of neurodevelopmental problems were born to mothers with a longer history of arthritis and were breastfeed for less than 6 months of age or were not breastfeed at all. No association was found with other maternal characteristics such as autoantibody existence and disease activity during and after the pregnancy. |
| first_indexed | 2024-12-14T14:42:55Z |
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| id | doaj.art-a648413f80ac42a585dcc5327df0e1b2 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-14T14:42:55Z |
| publishDate | 2021-03-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-a648413f80ac42a585dcc5327df0e1b22022-12-21T22:57:21ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122021-03-011210.3389/fphar.2021.626258626258The Influence of Treatment of Inflammatory Arthritis During Pregnancy on the Long-Term Children’s OutcomeCecilia Nalli0Jessica Galli1Daniele Lini2Daniele Lini3Angela Merlini4Silvia Piantoni5Silvia Piantoni6Maria Grazia Lazzaroni7Maria Grazia Lazzaroni8Victoria Bitsadze9Jamilya Khizroeva10Sonia Zatti11Laura Andreoli12Laura Andreoli13Elisa Fazzi14Franco Franceschini15Franco Franceschini16Alexander Makatsariya17Yehuda Shoenfeld18Yehuda Shoenfeld19Yehuda Shoenfeld20Angela Tincani21Angela Tincani22Angela Tincani23Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Brescia, ItalyChild Neurology and Psychiatry Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyChild Neurology and Psychiatry Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyDepartment of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, RussiaDepartment of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, RussiaObstetric and Gynecology Unit, ASST Spedali Civili of Brescia, Brescia, ItalyRheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyChild Neurology and Psychiatry Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyDepartment of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, RussiaDepartment of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, IsraelI.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, RussiaRheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyI.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, RussiaThe management of reproductive issues in women with inflammatory arthritis has greatly changed over decades. In the 1980–1990s, women with refractory forms of arthritis were either not able to get pregnant or did choose not to get pregnant because of their disabling disease. Hence, the traditional belief that pregnancy can induce a remission of arthritis. The availability of biologic agents has allowed a good control of aggressive forms of arthritis. The main topic of discussion during preconception counselling is the use of drugs during pregnancy and breastfeeding. Physicians are now supported by international recommendations released by the European League Against Rheumatism and the American College of Rheumatology, but still they must face with cultural reluctance in accepting that a pregnant woman can take medications. Patient-physician communication should be centered on the message that active maternal disease during pregnancy is detrimental to fetal health. Keeping maternal disease under control with drugs which are not harmful to the fetus is the best way to ensure the best possible outcome for both the mother and the baby. However, there might be concerns about the influence of the in utero exposure to medications on the newborn’s health conditions. Particularly, studies suggesting an increased risk of autism-spectrum-disorders in children born to women with rheumatoid arthritis has raised questions about neuropsychological impairment in the offspring of women with chronic arthritis. As a multidisciplinary group of rheumatologists and child neuropsychiatrists, we conducted a study on 16 women with chronic forms of arthritis whose diagnosis was determined before pregnancy and their 18 school-age children. The children underwent a complete neurological examination and validated tests/questionnaires. Behavioral aspects of somatization and anxiety/depression (internalizing problem) or an “adult profile” were found in nearly one third of children. Children at a high risk of neurodevelopmental problems were born to mothers with a longer history of arthritis and were breastfeed for less than 6 months of age or were not breastfeed at all. No association was found with other maternal characteristics such as autoantibody existence and disease activity during and after the pregnancy.https://www.frontiersin.org/articles/10.3389/fphar.2021.626258/fullrheumatoid arthritisspondyloarthritispsoriatic arthritispregnancyimmunosuppressantschildren’s development |
| spellingShingle | Cecilia Nalli Jessica Galli Daniele Lini Daniele Lini Angela Merlini Silvia Piantoni Silvia Piantoni Maria Grazia Lazzaroni Maria Grazia Lazzaroni Victoria Bitsadze Jamilya Khizroeva Sonia Zatti Laura Andreoli Laura Andreoli Elisa Fazzi Franco Franceschini Franco Franceschini Alexander Makatsariya Yehuda Shoenfeld Yehuda Shoenfeld Yehuda Shoenfeld Angela Tincani Angela Tincani Angela Tincani The Influence of Treatment of Inflammatory Arthritis During Pregnancy on the Long-Term Children’s Outcome Frontiers in Pharmacology rheumatoid arthritis spondyloarthritis psoriatic arthritis pregnancy immunosuppressants children’s development |
| title | The Influence of Treatment of Inflammatory Arthritis During Pregnancy on the Long-Term Children’s Outcome |
| title_full | The Influence of Treatment of Inflammatory Arthritis During Pregnancy on the Long-Term Children’s Outcome |
| title_fullStr | The Influence of Treatment of Inflammatory Arthritis During Pregnancy on the Long-Term Children’s Outcome |
| title_full_unstemmed | The Influence of Treatment of Inflammatory Arthritis During Pregnancy on the Long-Term Children’s Outcome |
| title_short | The Influence of Treatment of Inflammatory Arthritis During Pregnancy on the Long-Term Children’s Outcome |
| title_sort | influence of treatment of inflammatory arthritis during pregnancy on the long term children s outcome |
| topic | rheumatoid arthritis spondyloarthritis psoriatic arthritis pregnancy immunosuppressants children’s development |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2021.626258/full |
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