[CIS PIDD] [cis-pidd] Milder CVID phenotype with pregnancy

[Bodo Grimbacher]

In London and Freiburg we up the IgG replacement dose by 50% during the
last trimenon.
We also start IgG replacement in pregnant women who are below 6 g/L not
receiving replacement because they do not get infections for 3-4 IV
infusions. 
I am not aware of any evidence, though.
Best, Bodo


****************************************
Univ.-Prof. Dr. med. B. Grimbacher

Scientific-Director
CCI-Center for Chronic Immunodeficiency
UNIVERSITÄTSKLINIKUM FREIBURG
Tel.: 0761 270-77731  Fax: -77744
Engesserstraße 4, 79108 Freiburg
bodo.grimbacher at uniklinik-freiburg.de
www.uniklinik-freiburg.de/cci

and 

Consultant Immunologist
Institute of Immunity & Transplantation
Dept of Immunology
Royal Free Hospital

UNIVERSITY COLLEGE LONDON
Pond Street
London NW3 2QG
b.grimbacher at ucl.ac.uk
www.centreforimmunodeficiency.com











Am 05.06.14 18:29 schrieb "Kirkpatrick, Charles" unter
<Charles.Kirkpatrick at ucdenver.edu>:

>I have done that with patients during the late stages of pregnancy.  My
>rationale was the same as yours.  Of course there are no controls, but
>the babies had no problems with infections as neonates.
> 
>Chuck Kirkpatrick, M.D.
>Univ. of Colorado
> 
>From: Zachary D. Jacobs, MD [mailto:zjacobs.md at gmail.com]
>Sent: Wednesday, June 04, 2014 2:02 PM
>To: CIS-PIDD
>Subject: [cis-pidd] Milder CVID phenotype with pregnancy
> 
>Dear Colleagues,
>
> 
>
>I am following a 34 year old woman with a milder CVID phenotype
>characterized by an IgG in the mid 400s, IgA in the 30s, normal IgM and a
>moderate specific antibody deficiency with pre/post Pneumovax testing.
>Her pattern of infections has not been that bad at all and since her
>diagnosis about 18 months ago we have just been watching her and she has
>doing really well just with expectant/supportive therapy - no
>supplemental immunoglobulin.
>
> 
>
>She is now 21 weeks pregnant and still doing well. However, I was
>wondering if it might be beneficial to give her 1-2 doses of IVIG in the
>third trimester leading up to birth to optimize passive transfer of IgG
>to the baby, thinking that it might be better off for the infant to have
>a more "normal"  IgG at birth so the physiologic nadir won't hit rock
>bottom with him/her.
>
> 
>
>Any thoughts or experience with this scenario would be appreciated.
>
> 
>
>Thanks as always.
>
> 
>
>Zach
>
> 
>
>-- 
>Zachary D. Jacobs, M.D.
>
>The Center for Allergy & Immunology
>Kansas City Physician Partners
>Medical Plaza II
>
>4330 Wornall, Suite 40
>
>Kansas City, MO 64111
>
> 
>
>Ph: 816.531.0930
>
>Fax: 816.753.2671
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