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Abstract
BackgroundTo evaluate bone status in children born from mothers followed for autoimmune diseases and treated during pregnancy with low molecular weight heparin (LMVH) and/or prednisone.FindingsHistory, physical examination, laboratory tests and phalangeal ultrasonography were performed. Demographic, clinical, and laboratory data were entered into a customized database, and results were analyzed with SPSS software. In children whose mothers were treated with LMWH, we retrieved dried blood spots taken for newborn screening, and analyzed the presence of heparin with tandem mass spectrometry.We enrolled 27 females and 14 males born from 31 mothers with SLE or connective tissue diseases. These women were continuously treated during pregnancy with LMWH (n = 10), prednisone (n = 16), or both (n = 15). Bone ultrasound revealed low values (≤3 centile for age) in ten patients. In a multistep regression analysis, age at examination resulted the single predictor of low ultrasound values (p < 0.004). Tandem mass spectroscopy failed to determine traces of heparin in newborn blood.ConclusionsChildren born from mothers with autoimmune diseases are at risk to develop reduced bone mass. The administration of LMWH and of prednisone seems to be safe with regard to children’s bone health.
Highlights
To evaluate bone status in children born from mothers followed for autoimmune diseases and treated during pregnancy with low molecular weight heparin (LMVH) and/or prednisone
Both long-term lowmolecular-weight heparins (LMWH) therapy and corticosteroids may be associated with osteopenia in mothers, calcium and vitamin D supplementation seems to reduce the risk of drug-induced osteoporosis during pregnancy [7,8,9,10,11]
It has been shown that LMWHs do not seem to cross the placenta [12] and that they seem to be safe for the fetus, and it is known that prednisone and prednisolone are mostly inactivated by placental hydroxilase, their effects on bone status in children born from mothers treated with these drugs during pregnancy are currently unknown
Summary
To evaluate bone status in children born from mothers followed for autoimmune diseases and treated during pregnancy with low molecular weight heparin (LMVH) and/or prednisone. Bone health is influenced by genetic and environmental factors, some of which concern early childhood or even prenatal life [4,5,6]. In this regard, chronic maternal disease and maternal treatments could potentially have an impact on bone status of their offspring. It has been shown that LMWHs do not seem to cross the placenta [12] and that they seem to be safe for the fetus, and it is known that prednisone and prednisolone are mostly inactivated by placental hydroxilase, their effects on bone status in children born from mothers treated with these drugs during pregnancy are currently unknown
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