Anesthetic management of women with primary immunodeficiencies in the obstetric setting: A French cohort study (ANEU-DIP)

doi:10.1016/j.jacig.2025.100433

. 2025 Jan 30;4(2):100433.

doi: 10.1016/j.jacig.2025.100433. eCollection 2025 May.

Anesthetic management of women with primary immunodeficiencies in the obstetric setting: A French cohort study (ANEU-DIP)

Aude Beloeuvre¹, Olivia Anselem^{2

3}, Asmaa Tazi^{4

5

3}, Hawa Keita-Meyer^{6

7}, Nizar Mahlaoui^{8

9}, Caroline Charlier^{1

3

10

11}

Affiliations

¹ Infectious Diseases Unit, Paris Centre University Hospital, Paris, France.
² Department of Obstetrics, Paris Centre University Hospital, Paris, France.
³ University Hospital Federation Prem'impact, Paris, France.
⁴ Bacteriology Department, National Reference Center for Streptococci, Paris Centre University Hospital, Paris, France.
⁵ Institut Cochin, Team Bacteria and Perinatality, Université Paris Cité, Inserm U1016, CNRS UMR8104, Paris, France.
⁶ Obstetric and Pediatric Anesthesiology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Centre University Hospital, Paris, France.
⁷ Unité de Recherche EA 7323 Pharmacologie et Évaluation des Thérapeutiques Chez l'Enfant et la Femme Enceinte, Université de Paris Cité, Paris, France.
⁸ French National Reference Center for Primary Immune Deficiencies, Necker-Enfants malades University Hospital, AP-HP, Paris, France.
⁹ Pediatric Immuno-Hematology and Rheumatology Unit, Necker-Enfants malades University Hospital, AP-HP, Paris, France.
¹⁰ French National Reference Center and WHO Collaborating Center Listeria, Paris, France.
¹¹ Biology of Infection Unit, Inserm U1117, Institut Pasteur, Paris, France.

PMID: 40226770
PMCID: PMC11986503
DOI: 10.1016/j.jacig.2025.100433

Anesthetic management of women with primary immunodeficiencies in the obstetric setting: A French cohort study (ANEU-DIP)

Aude Beloeuvre et al. J Allergy Clin Immunol Glob. 2025.

. 2025 Jan 30;4(2):100433.

doi: 10.1016/j.jacig.2025.100433. eCollection 2025 May.

Authors

Aude Beloeuvre¹, Olivia Anselem^{2

3}, Asmaa Tazi^{4

5

3}, Hawa Keita-Meyer^{6

7}, Nizar Mahlaoui^{8

9}, Caroline Charlier^{1

3

10

11}

Affiliations

¹ Infectious Diseases Unit, Paris Centre University Hospital, Paris, France.
² Department of Obstetrics, Paris Centre University Hospital, Paris, France.
³ University Hospital Federation Prem'impact, Paris, France.
⁴ Bacteriology Department, National Reference Center for Streptococci, Paris Centre University Hospital, Paris, France.
⁵ Institut Cochin, Team Bacteria and Perinatality, Université Paris Cité, Inserm U1016, CNRS UMR8104, Paris, France.
⁶ Obstetric and Pediatric Anesthesiology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Centre University Hospital, Paris, France.
⁷ Unité de Recherche EA 7323 Pharmacologie et Évaluation des Thérapeutiques Chez l'Enfant et la Femme Enceinte, Université de Paris Cité, Paris, France.
⁸ French National Reference Center for Primary Immune Deficiencies, Necker-Enfants malades University Hospital, AP-HP, Paris, France.
⁹ Pediatric Immuno-Hematology and Rheumatology Unit, Necker-Enfants malades University Hospital, AP-HP, Paris, France.
¹⁰ French National Reference Center and WHO Collaborating Center Listeria, Paris, France.
¹¹ Biology of Infection Unit, Inserm U1117, Institut Pasteur, Paris, France.

PMID: 40226770
PMCID: PMC11986503
DOI: 10.1016/j.jacig.2025.100433

Abstract

Background: Primary immunodeficiencies (PIDs) encompass a large group of inherited diseases affecting the immune system. PID management is improving, enabling more patients to carry a pregnancy to term. Anesthetic care of those patients, especially obstetric neuraxial anesthesia and the associated infectious complications, has never been evaluated in this population.

Objective: This retrospective multicenter study aimed to assess the anesthetic management of women with PIDs during childbirth, focusing on potential infectious complications related to neuraxial anesthesia.

Methods: The medical records of 30 women aged 18 years or older, who are included in the French national PID registry (Reference Centre for Primary Immunodeficiencies [CEREDIH]) and who gave birth at one of the Assistance Publique-Hôpitaux de Paris maternity units between 2014 and 2024, were analyzed. Data on PID history, obstetric outcomes, and peripartum anesthesia were collected (the ANEU-DIP study, ClinicalTrials.gov identifier NCT06449066).

Results: We examined 51 deliveries (including 20 cesarean sections) among 30 women with PIDs (13 with predominantly antibody defects, 11 with T-cell immune deficiencies, and 6 with innate immune deficiencies). Of the 49 locoregional anesthesia procedures performed, 36 were epidurals, 8 were spinals, and 5 were combined spinal-epidurals. No anesthesia-related complications were reported. The distribution and severity of PIDs in the cohort were consistent with those in other French studies. Three intrauterine infections were identified, of which 2 were associated with known risk factors and subsequent favorable maternal and neonatal outcomes.

Conclusion: This study highlights the frequent use of neuraxial anesthesia in women with PIDs. No anesthesia-related complications were observed. Further research is needed to implement tailored anesthesia guidelines for this vulnerable segment of the pregnant population.

Keywords: Primary immune deficiency; anesthesia; chronic diseases; inborn errors of immunity; infection; intervention; neonate; outcome; pregnancy; rare diseases; registry.

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References

1. Bousfiha A.A., Jeddane L., Ailal F., Benhsaien I., Mahlaoui N., Casanova J.L., et al. Primary immunodeficiency diseases worldwide: more common than generally thought. J Clin Immunol. 2013;33:1–7. - PubMed
1. Mallart E., Françoise U., Driessen M., Blanche S., Lortholary O., Lefort A., et al. Pregnancy in primary immunodeficiency diseases: the PREPI study. J Allergy Clin Immunol. 2023;152:760–770. - PubMed
1. Le Ray C., Lelong N., Cinelli H., Blondel B., et al. ENP2021 Study Group Results of the 2021 French National Perinatal Survey and trends in perinatal health in metropolitan France since 1995. Journal of Gynecology Obstetrics and Human Reproduction, 1 déc. 2022;51(10) - PubMed
1. Horlocker T.T., Wedel D.J. Infectious complications of regional anesthesia. Best Pract Res Clin Anaesthesiol. 2008;22:451–475. - PubMed
1. Beucher G., Charlier C., Cazanave C. Infection intra-utérine: diagnostic et traitement. RPC rupture prématurée des membranes avant terme CNGOF. [Diagnosis and management of intra-uterine infection: CNGOF Preterm Premature Rupture of Membranes Guidelines] Gynecol Obstet Fertil Senol. 2018;46:1054–1067. - PubMed

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[1] Bousfiha A.A., Jeddane L., Ailal F., Benhsaien I., Mahlaoui N., Casanova J.L., et al. Primary immunodeficiency diseases worldwide: more common than generally thought. J Clin Immunol. 2013;33:1–7. - PubMed

[2] Bousfiha A.A., Jeddane L., Ailal F., Benhsaien I., Mahlaoui N., Casanova J.L., et al. Primary immunodeficiency diseases worldwide: more common than generally thought. J Clin Immunol. 2013;33:1–7. - PubMed

[3] Mallart E., Françoise U., Driessen M., Blanche S., Lortholary O., Lefort A., et al. Pregnancy in primary immunodeficiency diseases: the PREPI study. J Allergy Clin Immunol. 2023;152:760–770. - PubMed

[4] Mallart E., Françoise U., Driessen M., Blanche S., Lortholary O., Lefort A., et al. Pregnancy in primary immunodeficiency diseases: the PREPI study. J Allergy Clin Immunol. 2023;152:760–770. - PubMed

[5] Le Ray C., Lelong N., Cinelli H., Blondel B., et al. ENP2021 Study Group Results of the 2021 French National Perinatal Survey and trends in perinatal health in metropolitan France since 1995. Journal of Gynecology Obstetrics and Human Reproduction, 1 déc. 2022;51(10) - PubMed

[6] Le Ray C., Lelong N., Cinelli H., Blondel B., et al. ENP2021 Study Group Results of the 2021 French National Perinatal Survey and trends in perinatal health in metropolitan France since 1995. Journal of Gynecology Obstetrics and Human Reproduction, 1 déc. 2022;51(10) - PubMed

[7] Horlocker T.T., Wedel D.J. Infectious complications of regional anesthesia. Best Pract Res Clin Anaesthesiol. 2008;22:451–475. - PubMed

[8] Horlocker T.T., Wedel D.J. Infectious complications of regional anesthesia. Best Pract Res Clin Anaesthesiol. 2008;22:451–475. - PubMed

[9] Beucher G., Charlier C., Cazanave C. Infection intra-utérine: diagnostic et traitement. RPC rupture prématurée des membranes avant terme CNGOF. [Diagnosis and management of intra-uterine infection: CNGOF Preterm Premature Rupture of Membranes Guidelines] Gynecol Obstet Fertil Senol. 2018;46:1054–1067. - PubMed

[10] Beucher G., Charlier C., Cazanave C. Infection intra-utérine: diagnostic et traitement. RPC rupture prématurée des membranes avant terme CNGOF. [Diagnosis and management of intra-uterine infection: CNGOF Preterm Premature Rupture of Membranes Guidelines] Gynecol Obstet Fertil Senol. 2018;46:1054–1067. - PubMed

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Anesthetic management of women with primary immunodeficiencies in the obstetric setting: A French cohort study (ANEU-DIP)

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Anesthetic management of women with primary immunodeficiencies in the obstetric setting: A French cohort study (ANEU-DIP)

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