Table 3

Pregnancies complicated by neonatal hematologic abnormalities or infections

CountryAge, yIndicationNarrativeRituximab eosePregnancy outcomeHematologic abnormalityFollow-upInfection
France10  41 AIHA Rituximab inadvertently administered between weeks 7 and 10 of pregnancy 375 mg/m2 weekly × 4 Female, 40 wk Low WBC count None reported None 
United States NR Transplant rejection Kidney/pancreas transplant rejection prevention treatment Not reported Baby B-cell depleted None reported None 
United Kingdom 28 ITP Rituximab administered during seventh month Unreported dose weekly × 4 Female, 39 wk; cerebral hemorrhage Thrombocytopenia Normal platelets at 4 mo None 
Canada 35 ITP Rituximab administered in sixth month; amniocentesis previously diagnosed Turner mosaic Unreported dose over a 4-wk period Female, 36 wk; Turner mosaic syndrome Absent B cells at 1 wk None reported None 
Sweden3  37 NHL Pregnancy occurred within 1 mo of rituximab 375 mg/m2 weekly × 4 Female, 40 wk Low granulocyte count Normalized by 18 mo; normal response to vaccinations None 
France 20 NHL Rituximab administered at 28 wk of gestation Unreported dose weekly × 4 Female, 33 wk Neutropenia, anemia Normalized in 3 d None 
France 45 ITP Rituximab administered at 33 wk gestation 375 mg/m2 at week 33 and 35 Male, 35 wk Lymphopenia None reported None 
United States 22 RA Pregnancy occurred 4 mo after last rituximab administration 1 g every 14 d × 2 Female, 41 wk, respiratory distress Mild thrombocytopenia None reported None 
Switzerland6  35 NHL Rituximab + CHOP administered at 16 wk of gestation 375 mg/m2 weekly × 4 Female, 41 wk Rituximab in cord blood, B-cell depletion Recovered by 12 wk None 
Switzerland5  31 NHL Rituximab + CHOP administered at 15 weeks gestation 375mg/m2 every 14 days × 6 female, 33 weeks Low b cells at birth. Immunoglobulins normal Normalized by week 12 None 
France 19 ITP Rituximab administered during seventh month; mother had CMV infection during pregnancy 375 mg/m2 weekly × 2 Male, 36 wk Thrombocytopenia None reported CMV hepatitis, vertical transmission 
Australia 33 NHL Patient was treated with rituximab + CHOP before pregnancy 375 mg/m2 every 14 d Male, 35 wk None None reported Bronchiolitis 
United States 30s SLE 18 mo after rituximab 1 g every 14 d × 2, repeat at 6 mo Premature infant, 36 wk None None reported Acute chorioamnionitis diagnosed on placental pathology 
Norway 32 ITP 9 mo after rituximab Not reported Male, 41 wk None None reported Fever at 3 wk old, presumed to be viral 
CountryAge, yIndicationNarrativeRituximab eosePregnancy outcomeHematologic abnormalityFollow-upInfection
France10  41 AIHA Rituximab inadvertently administered between weeks 7 and 10 of pregnancy 375 mg/m2 weekly × 4 Female, 40 wk Low WBC count None reported None 
United States NR Transplant rejection Kidney/pancreas transplant rejection prevention treatment Not reported Baby B-cell depleted None reported None 
United Kingdom 28 ITP Rituximab administered during seventh month Unreported dose weekly × 4 Female, 39 wk; cerebral hemorrhage Thrombocytopenia Normal platelets at 4 mo None 
Canada 35 ITP Rituximab administered in sixth month; amniocentesis previously diagnosed Turner mosaic Unreported dose over a 4-wk period Female, 36 wk; Turner mosaic syndrome Absent B cells at 1 wk None reported None 
Sweden3  37 NHL Pregnancy occurred within 1 mo of rituximab 375 mg/m2 weekly × 4 Female, 40 wk Low granulocyte count Normalized by 18 mo; normal response to vaccinations None 
France 20 NHL Rituximab administered at 28 wk of gestation Unreported dose weekly × 4 Female, 33 wk Neutropenia, anemia Normalized in 3 d None 
France 45 ITP Rituximab administered at 33 wk gestation 375 mg/m2 at week 33 and 35 Male, 35 wk Lymphopenia None reported None 
United States 22 RA Pregnancy occurred 4 mo after last rituximab administration 1 g every 14 d × 2 Female, 41 wk, respiratory distress Mild thrombocytopenia None reported None 
Switzerland6  35 NHL Rituximab + CHOP administered at 16 wk of gestation 375 mg/m2 weekly × 4 Female, 41 wk Rituximab in cord blood, B-cell depletion Recovered by 12 wk None 
Switzerland5  31 NHL Rituximab + CHOP administered at 15 weeks gestation 375mg/m2 every 14 days × 6 female, 33 weeks Low b cells at birth. Immunoglobulins normal Normalized by week 12 None 
France 19 ITP Rituximab administered during seventh month; mother had CMV infection during pregnancy 375 mg/m2 weekly × 2 Male, 36 wk Thrombocytopenia None reported CMV hepatitis, vertical transmission 
Australia 33 NHL Patient was treated with rituximab + CHOP before pregnancy 375 mg/m2 every 14 d Male, 35 wk None None reported Bronchiolitis 
United States 30s SLE 18 mo after rituximab 1 g every 14 d × 2, repeat at 6 mo Premature infant, 36 wk None None reported Acute chorioamnionitis diagnosed on placental pathology 
Norway 32 ITP 9 mo after rituximab Not reported Male, 41 wk None None reported Fever at 3 wk old, presumed to be viral 

AIHA indicates autoimmune hemolytic anemia; WBC, white blood cell; NR, not reported; ITP, idiopathic thrombocytopenia purpura; NHL, non-Hodgkin lymphoma; RA, rheumatoid arthritis; CHOP, cyclophosphamide, doxorubicin, vincristine, prednisone; CMV, cytomegalovirus; and SLE, systemic lupus erythematosus.

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