High Cytokines in Pregnancy

LollyPop

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Reply High Cytokines in Pregnancy Posted on: Oct 28, 2011 at 2:14pm
Hello Dr Braverman,

I am writing to you for your advice on my high cytokines.

I am currently 11 weeks 4 days pregnant (4th IVF, 1 previous live birth, 2 ectopics, 1 chemical pregnancy).

I have had extensive immune testing carried out with results being: NK cells within range, no DQ-alpha matches etc. The only thing that was flagged up was low LAD and high cytokines.

After treating the cytokines with 4 shots of Humira (pre IVF), my cytokines flared to over 40. Since pregnancy, they have rocketed to near 60! I have had IVIG almost every 3 weeks since and have not seen a decrease in these levels. I am also taking 40mg of prednisolne daily, although I expect to come off that shortly.

My question is: would Intralpids be a better choice to reduce the cytokines? I am obviously worried about switching but the cost of IVIG every 3 weeks is just so expensive. Would intralipds protect a pregnancy like IVIG? Obviously if IVIG is the best thing then we will stick with that.

I welcome any advice you can offer - this is such a worry for me.

Thank you in advance.

Dr. Braverman

2024 Posts
Re: High Cytokines in Pregnancy Posted on: Oct 28, 2011 at 6:35pm
second trimester elevation of cytokines is still a debatable issue as far as its relevance to fetal loss. some data even suggest TNF may be necessary in the second trimester for fetal development . I try and keep track of the other immune cells as well. The prednisone also interferes with the action of the cytokines as well as decrease the production, so even if still elevated the they may not have any detrimental effects. lastly it must be remembered that what you are looking at is a ratio of TNF/IL10 and it may be that IL10 is low for some reason but not that the TNF is elevated, hence looking for other signs of cellular response to the ? elevated TNF. I have not found ILs to be better than IVIG for reducing TNF(or INFgamma) production.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

LollyPop

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Reply Re: High Cytokines in Pregnancy Posted on: Nov 8, 2011 at 10:53am
Thank you, Doctor, for your response.

Can I ask when you recommend weaning off steroids in pregnancy? Is there a point at which steroids become harmful to a pregnancy?

Also, in your experience, is it common to see a cytokine flare after stopping, or reducing steroids? For this, I assume your recommended treatment would be IVIG?

Thank you for your time, I appreciate your opinion.

Dr. Braverman

2024 Posts
Re: High Cytokines in Pregnancy Posted on: Nov 9, 2011 at 1:34am
There is no evidence that stopping prednisone will give you a flare in your cytokine response. The risk of prednisone increases after 24 weeks when the enzyme that breaks it down and prevents most of it from crossing the placenta to the baby is no longer functioning. But most patients stop thier prednisone no later than 14 weeks regardless.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.