Abstract Number: PB1082
Meeting: ISTH 2020 Congress
Background: The role of the gut microbiota on the immune system in haemophilia A is a potential risk factor for the development of anti-Factor VIII inhibitory antibodies. The infant gut microbiota has never been directly investigated in the haemophilia population. However, the mode of delivery is proposed to be a major influence on the composition of the early gut microbiota.
Aims: The aim of the study was to compare the incidence of inhibitors in children born by vaginal delivery and cesarean section.
Methods: Data was analysed using SPSS.
Results: 956 children with severe haemophilia A that had reached 50 exposure days of FVIII treatment before their second birthday were included in this PedNet multicentre study. A family history of HA was identified in 45.1% (n=431) and prenatal diagnosis made in 6.3% (n=59). There were 337 cases of inhibitors in total. 60.4% (n=577) had a high-risk genetic mutation, 9.5% (n=91) had a family history of inhibitors and 14.5% (n=139) had intensive first treatment. Cesarean section was performed in 33.4% (n=320). No difference in risk of inhibitor development was observed in infants born by cesarean section compared to vaginal delivery overall (36.0% vs 31.3%, OR 1.15, CI 0.95-1.38). Additionally, cesarean section delivery was added into a logistic regression model using the established risk factors of (a) family history of inhibitors, (b) high risk genetic mutation and (c) intensive first treatment, and no improvement in model performance was observed. Further separate analyses of 8 subgroups defined by a combination of the presence or absence of the three previously mentioned established risk factors also showed no difference in the rate of inhibitor development (table 1) although the numbers of inhibitor positive patients in these subgroups was small.
Conclusions: In summary, no difference in the risk of inhibitor development was found between infants born by vaginal delivery or cesarean section.
To cite this abstract in AMA style:Tarrant J, Andersson N, Chalmers E, Kenet G, Ljung R, Mäkipernaa A, Chambost H, van den Berg M, PedNet Study Group . Mode of Delivery in Haemophilia: Vaginal Delivery and Cesarean Section Carry Similar Risk for Inhibitor Development in Severe Haemophilia A [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/mode-of-delivery-in-haemophilia-vaginal-delivery-and-cesarean-section-carry-similar-risk-for-inhibitor-development-in-severe-haemophilia-a/. Accessed May 16, 2022.
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