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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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Autores principales: Nalli, Cecilia, Galli, Jessica, Lini, Daniele, Merlini, Angela, Piantoni, Silvia, Lazzaroni, Maria Grazia, Bitsadze, Victoria, Khizroeva, Jamilya, Zatti, Sonia, Andreoli, Laura, Fazzi, Elisa, Franceschini, Franco, Makatsariya, Alexander, Shoenfeld, Yehuda, Tincani, Angela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013697/
https://www.ncbi.nlm.nih.gov/pubmed/33815108
http://dx.doi.org/10.3389/fphar.2021.626258
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author Nalli, Cecilia
Galli, Jessica
Lini, Daniele
Merlini, Angela
Piantoni, Silvia
Lazzaroni, Maria Grazia
Bitsadze, Victoria
Khizroeva, Jamilya
Zatti, Sonia
Andreoli, Laura
Fazzi, Elisa
Franceschini, Franco
Makatsariya, Alexander
Shoenfeld, Yehuda
Tincani, Angela
author_facet Nalli, Cecilia
Galli, Jessica
Lini, Daniele
Merlini, Angela
Piantoni, Silvia
Lazzaroni, Maria Grazia
Bitsadze, Victoria
Khizroeva, Jamilya
Zatti, Sonia
Andreoli, Laura
Fazzi, Elisa
Franceschini, Franco
Makatsariya, Alexander
Shoenfeld, Yehuda
Tincani, Angela
author_sort Nalli, Cecilia
collection PubMed
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.
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spelling pubmed-80136972021-04-02 The Influence of Treatment of Inflammatory Arthritis During Pregnancy on the Long-Term Children’s Outcome Nalli, Cecilia Galli, Jessica Lini, Daniele Merlini, Angela Piantoni, Silvia Lazzaroni, Maria Grazia Bitsadze, Victoria Khizroeva, Jamilya Zatti, Sonia Andreoli, Laura Fazzi, Elisa Franceschini, Franco Makatsariya, Alexander Shoenfeld, Yehuda Tincani, Angela Front Pharmacol Pharmacology 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. Frontiers Media S.A. 2021-03-18 /pmc/articles/PMC8013697/ /pubmed/33815108 http://dx.doi.org/10.3389/fphar.2021.626258 Text en Copyright © 2021 Nalli, Galli, Lini, Merlini, Piantoni, Lazzaroni, Bitsadze, Khizroeva, Zatti, Andreoli, Fazzi, Franceschini, Makatsariya, Shoenfeld and Tincani. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Nalli, Cecilia
Galli, Jessica
Lini, Daniele
Merlini, Angela
Piantoni, Silvia
Lazzaroni, Maria Grazia
Bitsadze, Victoria
Khizroeva, Jamilya
Zatti, Sonia
Andreoli, Laura
Fazzi, Elisa
Franceschini, Franco
Makatsariya, Alexander
Shoenfeld, Yehuda
Tincani, Angela
The Influence of Treatment of Inflammatory Arthritis During Pregnancy on the Long-Term Children’s Outcome
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 Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013697/
https://www.ncbi.nlm.nih.gov/pubmed/33815108
http://dx.doi.org/10.3389/fphar.2021.626258
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