Sustained suppression of the B cell compartment can lead to impairment of T cell responses, resulting in a prolonged immunosuppressive

state with an increased risk of vertical transmission of cytomegalovirus (CMV) infection from mother to fetus [112]. Pan-specific depletion of B cells can deplete autoantibodies as well as protective natural antibodies and regulatory B cell subsets [5]. Therefore, it is clear that carefully planned clinical trials are needed to evaluate selleck the full benefits and harms of rituximab in pregnancy before it can be recommended for wider use in pregnancy. The evidence presented in this review has clearly highlighted the important role of B cells in shaping pregnancy outcomes that have implications for long-term MAPK Inhibitor Library human health. Despite this, there are still limited data detailing the changes in the human B cell compartment, and the role of B cell subsets in pregnancy outcomes is poorly studied. This is due to the limited

number of B cell markers used in earlier studies to describe changes in B cell subsets during pregnancy. Recent advances in B cell biology indicate clearly that these markers alone are not adequate in describing their full functions in human pregnancy. Further efforts should be dedicated to delineate the contribution of these B cell subsets in the maintenance of a healthy pregnancy as well as their roles in pregnancy complications. In light of the potential benefits of rituximab in depleting autoreactive B cells and the emerging safety profile of rituximab in pregnancy, it is anticipated that B cell depletion therapies will eventually be trialled in obstetric complications that involve autoantibodies such as APS, SLE or ITP. It is reasonable to expect that rituximab will make some advances in the treatment of refractory conditions in pregnancy and provide a viable option that spares the use of high doses of chemotherapeutics

and steroids in high-risk pregnancy to reduce risk of fetal toxicity [115], and thereby allows the pregnancy a better chance to develop to full term. Future pilot studies into the Avelestat (AZD9668) safety and efficacy of rituximab in pregnant patient cohorts are needed to provide a rational basis for larger studies. Although B cell depletion has demonstrated clinical benefits for maternal conditions in high-risk pregnancies, its potential benefits and risks for neonatal outcomes have not yet been investigated fully. It remains to be determined whether or not B cell depletion can improve neonatal outcomes on preterm birth, low birth weights, congenital malformations and their associated long-term health consequences.