Case Report
Neonatal pancytopenia in a child, born after maternal exposure to natalizumab throughout pregnancyPancytopénie néonatale chez une enfant née après une exposition maternelle au natalizumab durant toute la grossesse

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Abstract

Natalizumab is a monoclonal antibody indicated for the treatment of patients with relapsing-remitting multiple sclerosis. Its use is prohibited during pregnancy. However, natalizumab exposures throughout the gestation period or during the third trimester, because of intense disease activity, are possible and begin to be reported. There are enough reassuring arguments against a teratogenicity, through pregnancy registries; but deleterious effects in the monitoring of newborn, are not well known. A disorder of hematopoiesis is possible with anemia, thrombocytopenia or pancytopenia, as discussed by the author through an observation. These hematological disorders seem to be asymptomatic; they resolve spontaneously and require a simple biological and clinical monitoring of the newborn.

Résumé

Le natalizumab est un anticorps monoclonal indiqué dans le traitement de patients souffrant de sclérose en plaque rémittente récurrente. En théorie, son utilisation est contre-indiquée durant la grossesse; toutefois les données provenant des registres de surveillance de grossesse confortent l’hypothèse d’une absence de risque majeur pour les fœtus, notamment tératogène. En revanche un éventuel effet délétère sur l’enfant dans son suivi post-natal n’est pas bien connu. Un trouble de l’hématopoïèse est possible comme l’illustrent les auteurs au travers d’une observation d’une enfant ayant présenté à la naissance une pancytopénie, spontanément résolutive. Une attention doit être portée sur ce risque hématologique, avec une information donnée à l’équipe gynécologique et obstétricale par le neurologue traitant.

Introduction

Natalizumab (NTZ) is a monoclonal antibody indicated for the treatment of second line in patients with recurrent relapsing-remitting multiple sclerosis (RRMS).

According to the recommendations of good practice, its use is theoretically prohibited during the pregnancy, the product being classified as C by the Food Drug Administration [1]. However, prolonged exposure during pregnancy, particularly as a result of persistent disease, are possible [2], [3], [4], [5], [6].

Section snippets

Observation

The case of a 27-year-old Caucasian woman is reported, with exposure to NTZ throughout pregnancy. The patient was followed for a 7-year RRMS with an active form of the disease, marked by medullary relapses. After the birth of her second child, she presented a vestibular relapse with an aggravation of the MRI parameters. She accepted a treatment with NTZ, which began on April 29, 2014. Despite medical recommendations for effective contraception, the patient began a third pregnancy, after 3

Discussion

Despite recommendations of good practice, exposures throughout pregnancy of the third trimester, due to an intense activity of the disease are possible and begin to be reported [2], [3], [4], [5], [6]. These decisions may be specific to patients: they can decide not to inform their neurologist of their pregnancy status as [4]; these decisions may follow a reflection between the neurologist and his patient during a “benefit–risk” reflection [5], [6]. As much as there are safety arguments for

Conclusion

During prolonged exposure to NTZ throughout the pregnancy or during its prescription during the 3rd trimester, it is necessary to remain attentive to a possible haematological risk for the newborn. This requires good coordination between the neurologist and the gynaecological or paediatric team. This observation also advocates the need to strengthen the registry of pregnancies exposed to NTZ with monitoring of the biological blood data of these newborns. One question that can be asked is the

Disclosure of interest

The authors declare that they have no competing interest.

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