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

## TL;DR

This study examines the anesthetic management of pregnant women with primary immunodeficiencies in France, finding no anesthesia-related complications.

## Contribution

The study is the first to evaluate anesthetic care and infectious complications in women with PIDs during childbirth.

## Key findings

- Neuraxial anesthesia was frequently used with no reported complications.
- Three intrauterine infections occurred, but two had favorable outcomes.
- PID distribution in the cohort matched other French studies.

## Abstract

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.

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.

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).

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.

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.