Rituximab, a chimeric human and murine monoclonal antibody, targets the CD20 antigen expressed on pre-B cells and mature B-lymphocytes [55]. The antibody was originally developed for the treatment of B-cell lymphoma [56]. Recently, it has been administered for treating different autoimmune disease.
As rituximab is an IgG1 subclass antibody, it crosses the placenta, interfering with fetal and neonatal B cell development and could lead to immune deficiency and raise susceptibility to infections in the neonate [57]. However, few data are available on the use of rituximab during pregnancy [57,58]. During the second and third trimesters, its fetal serum levels could be similar to or exceeds maternal levels at term [57,59,60]. It is not clear that preconceptional or first trimester exposure to …show more content…
In contrast, B-cell depletion in the fetus and unknown long-term effects on the child would be a result of second and third trimester exposure to this drug [57]. Although FDA suggests rituximab discontinuation 12 months before pregnancy (http://www. fda.gov/downloads/Drugs/ /DrugSafety/UCM169892.pdf), discontinuation of rituximab 6 months before conception may be sufficient and not expose the baby to detrimental effect [64]. In an experience with low-dose rituximab, this agent administered seven months before pregnancy and two days after delivery at a dose of 100 mg. the patient remained stable throughout these periods. Reduced B lymphocyte levels in the umbilical blood returned to normal after three months, demonstrating a sustained but transient biological effect of low-dose rituximab on the newborn, s immune system. The authors found that deportation of anti-AQP-4 antibody from the mother to the child is possible and may not have adverse effects on the child. The pregnancy outcome was a full term male child with no neurological or other
As rituximab is an IgG1 subclass antibody, it crosses the placenta, interfering with fetal and neonatal B cell development and could lead to immune deficiency and raise susceptibility to infections in the neonate [57]. However, few data are available on the use of rituximab during pregnancy [57,58]. During the second and third trimesters, its fetal serum levels could be similar to or exceeds maternal levels at term [57,59,60]. It is not clear that preconceptional or first trimester exposure to …show more content…
In contrast, B-cell depletion in the fetus and unknown long-term effects on the child would be a result of second and third trimester exposure to this drug [57]. Although FDA suggests rituximab discontinuation 12 months before pregnancy (http://www. fda.gov/downloads/Drugs/ /DrugSafety/UCM169892.pdf), discontinuation of rituximab 6 months before conception may be sufficient and not expose the baby to detrimental effect [64]. In an experience with low-dose rituximab, this agent administered seven months before pregnancy and two days after delivery at a dose of 100 mg. the patient remained stable throughout these periods. Reduced B lymphocyte levels in the umbilical blood returned to normal after three months, demonstrating a sustained but transient biological effect of low-dose rituximab on the newborn, s immune system. The authors found that deportation of anti-AQP-4 antibody from the mother to the child is possible and may not have adverse effects on the child. The pregnancy outcome was a full term male child with no neurological or other