Neuropsychological development of children born to patients with antiphospholipid syndrome

Abstract

Objective. To verify the occurrence of learning disabilities (LDs) in the offspring of women with primary antiphospholipid syndrome (APS) as a consequence of fetal exposure to maternal antiphospholipid antibodies (aPL), and to evaluate the impact of maternal chronic disease on children's development. Methods. We studied 17 children of mothers with primary APS using a standardized intelligence test (Wechsler Intelligence Scale for Children, Revised), a specific LD battery of tests (Sartori, MT groups' test for reading ability, MT groups' test for math skills), and a questionnaire on behavioral and social characteristics (Child Behavior Checklist [CBCL]). Mothers were interviewed about their pregnancy and motherhood experience. Results. All children had a normal intelligence level (full-scale intelligence quotient >85); 15 pregnancies occurred in mothers with IgG aPL. LDs were diagnosed in 4 children (26.7%), 2 boys and 2 girls. One of these children was born premature, with a brother also affected. Four children (26.7%) showed a higher risk to present problems on the CBCL total competence scale and 2 children (13.3%) on the CBCL total behavior scale. Two children were described as hyperactive (1 had an LD). All families had a good socioeconomic status and educational level. Conclusion. Besides prematurity and genetic and environmental factors, the genesis of LDs may also include in utero exposure to aPL, in agreement with described experimental models and patients with systemic lupus erythematosus. Socioeconomic status does not seem to influence the occurrence of LDs. A long-term multidisciplinary followup may improve quality of life in patients with primary APS and their children.

Pregnancy implications for systemic lupus erythematosus and the antiphospholipid syndrome

“…However, an increased prevalence of LD or behavioural problems failed to be confirmed by more recent studies on children born to mothers with anti-Ro/SSA, even when subgrouped for NL manifestations and exposure in utero to dexamethasone [143,144]. The exposure to maternal aPL was also linked to LD in children born to both mothers with SLE [139] and with APS [145]; prematurity was not associated with LD in these studies.…”

The effects of lupus and antiphospholipid antibody syndrome on foetal outcomes

“…Between 1992 and 1999, three case-control studies of infants born to mothers with APS showed that there was no statistically significant difference in severe and minor neonatal complications, which were mainly related to prematurity. 33,35,36 In one of these studies there was no adverse outcome related to APS and at paediatric follow-up all children were normal on neurodevelopmental and physical examination. 31 Another retrospective study of 55 newborns of mothers with primary APS showed that the majority of neonatal complications were closely linked to prematurity.…”

Dialogue: Increased usage of special educational services by children born to mothers with systemic lupus erythematosus and antiphospholipid antibodies

“…Multivariate analysis showed that APS is associated with a threefold to eightfold increase in any use of SE services, consistent with a prior report of increased LD in offspring of patients with primary APS. 4 …”