Key result
Preemptive immunotherapy with plasmapheresis and IVIg initiated at week 10 of gestation resulted in the delivery of a healthy infant after three previous fetal losses due to FARAD.
Why the study?
Maternal antibodies against fAChR can cause FARAD with high recurrence rates, and while it may respond to maternal immunotherapy, standardized treatment protocols are lacking.
Does preemptive immunotherapy with PLEX and IVIg prevent FARAD-related pregnancy losses in asymptomatic mothers with fAChR antibodies?
Case Report (n=1)
Does preemptive immunotherapy with PLEX and IVIg prevent FARAD-related pregnancy losses in asymptomatic mothers with fAChR antibodies?
Early, preemptive immunotherapy with PLEX and IVIg may prevent FARAD-related pregnancy losses in asymptomatic mothers with fAChR antibodies.
Answers are grounded in this paper and cite their sources.
May support maternal immunotherapy in fAChR-positive pregnancies; leaves open standardized protocols and prospective trials.
Maternal antibodies against the fetal acetylcholine receptor (fAChR) can cause fetal acetylcholine receptor antibody-related disorders (FARAD), a rare but important cause of arthrogryposis multiplex congenita (AMC) and Fetal Akinesia Deformation Sequence (FADS), with recurrence rates up to 100%. Unlike genetic causes, FARAD may respond to maternal immunotherapy, yet standardized treatment protocols are lacking. We report four pregnancies in an asymptomatic mother with confirmed fAChR antibodies. After three fetal losses due to FARAD and two unsuccessful treatment attempts initiated only after sonographic abnormalities, a healthy infant was delivered in the fourth pregnancy following a pre-planned preemptive approach. Treatment, initiated at week 10 of gestation, consisted of plasmapheresis (PLEX) and subsequent weekly high-dose intravenous immunoglobulin (IVIg). Fetal serum after birth confirmed fAChR antibodies on cell-based assays (live and fixed). This case series underscores the importance of recognizing fAChR antibodies as differential diagnosis of AMC in asymptomatic mothers and of early, consistent antibody-reducing therapy to prevent FARAD-related pregnancy losses.
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Verlohren et al. (2026) conducted a case report in Fetal acetylcholine receptor antibody disorder (FARAD) (n=1). Preemptive immunotherapy (plasmapheresis and IVIg) was evaluated on Delivery of a healthy infant. Preemptive immunotherapy with plasmapheresis and IVIg initiated at week 10 of gestation resulted in the delivery of a healthy infant after three previous fetal losses due to FARAD.
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