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In the United States, Down syndrome occurs in 1 of every 800 infants with many as 6,000 children born with Down syndrome each year. Down syndrome can be caused by one of three types of abnormal cell division involving chromosome 21. Translocation Trisomy 21-Sometimes (in 3-4% of cases) part of chromosome 21 becomes attached (translocated) to another chromosome (usually the 13th, 14th or 15th chromosome) before or at conception. For couples who have had one child with Down syndrome due to translocation trisomy 21, there may be an increased likelihood of Down syndrome in future pregnancies. The chance of passing the translocation depends on the sex of the parent who carries the rearranged chromosome 21. In all cases of Down syndrome, but especially in cases with translocation trisomy 21, it is important for the parents to have genetic counseling in order to determine their risk. Generally, couples who have had one child with Down syndrome have a slightly increased risk (about 1%) of having a second child with Down syndrome. Parents who are carriers of the genetic translocation for Down syndrome have an increased risk depending on the type of translocation.
There is no evidence of a man with Down syndrome fathering a child. While the incidence of births of children with Down syndrome increases with maternal age, more children are born to women under the age of 35 due to higher fertility rates. In the January issue of Obstetrics & Gynecology, the American College of Obstetricians and Gynecologists released guidelines recommending screening for Down syndrome to all pregnant women during their first trimester. Diagnostic tests tend to be more expensive and have a degree of risk; screening tests are quick and easy to do. Quad Marker Screen – Maternal blood is tested for four substances that normally come from a baby’s blood, brain, spinal fluid and amniotic fluid. Triple Screen – During the 16th and 18th week of pregnancy a blood test can be performed which measures the quantities of three substances: Alpha-fetoprotein (AFP) which is produced by the fetus, human chorionic gonadotropin (hCG), and unconjugated estriol which is produced by the placenta. If the screening tests are positive or a high risk for Down syndrome exists, further testing might be needed. It is important to discuss the risks and benefits of testing thoroughly with your health care provider. The general health and quality of life for people with Down syndrome has improved drastically in recent years.
Assemble a team of professionals –Find a team of health care providers, teachers, and therapists that you trust to work with you in providing the best care for your child. Seek out other families – Support from those who have had similar experiences with a Down syndrome child can be very beneficial. Don’t believe the myths about Down syndrome – Immense strides have been made in recent years with people who have Down syndrome.
Sign-Up For The APA NewsletterGet a roundup of all the best pregnancy news and tips from around the web with exclusive discounts and giveaways from our sponsors. The Association is only able to accomplish our mission with the commitment of people like you. Aplasia cutis congenita is a rare skin condition characterized by the absence of localized or widespread areas of skin at birth. Aplasia cutis congenita (ACC) is a condition characterized by the absence of skin at birth. A new born baby boy was seen in the neonatal Intensive Care Unit (ICU) just after birth, who had almost complete absence of the skin except for some area around the nose (Figure-1) and on the buttocks (Figure-2) where skin had formed. Pemphigus Vulgaris during pregnancy is very rare.1 Our case was further complicated by the birth of a neonate with extensive skin aplasia.

Our case is more likely associated with Type 8 ACC, which is the type associated with teratogens.
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It was first described in 1866 and is named after John Langdon Down, the doctor who first identified the syndrome. It is estimated that about 85% of infants with Down syndrome survive one year and 50% of those will live longer than 50 years. An extra chromosome (chromosome 21) originates in the development of either the sperm or the egg. While similar to simple trisomy 21, the difference is that the extra chromosome 21 is present in some, but not all cells, of the individual.
The carrier (the one having the translocated chromosome) will have 45 chromosomes instead of 46 but they will have all the genetic material of a person with 46 chromosomes. If the father is the carrier, the risk is about 3 percent, with the mother as the carrier, the risk is about 12 percent. Therefore, prenatal screening and genetic counseling are important. People with Down syndrome rarely reproduce. Screening tests do not provide conclusive answers, but rather, they provide an indication of the likelihood of the baby having Down syndrome. If the screening test is positive and a risk for Down syndrome exists, further testing may be recommended.
However, screening tests have a greater chance of being wrong; there are “false-positive” (test indicates the baby has the condition when the baby really does not) and “false-negatives” (baby has the condition but the test indicates they do not). These screening tests do not provide conclusive answers but provide an indication of the likelihood of the baby having Down syndrome.
In determining the results of the test, health care providers take into account the mother’s age, weight and ethnicity. If some or all of the characteristic Down syndrome features are present, the health care provider will order a chromosomal karyotype test to be done.
Your health care provider will help you decide if the benefits from the results could outweigh any risks from the procedure.
Mental and physical developments are usually slower in people with Down syndrome than for those without the condition. However, children with Down syndrome would benefit from early medical assistance and developmental interventions beginning during infancy. Children with Down syndrome may benefit from speech therapy, physical therapy and occupational therapy.
Many adult patients are healthier, live longer, and participate more actively in society due to early intervention and therapy. These support groups can be found through local hospitals, physicians, schools and the Internet.
Your tax deductible contribution provides valuable education and more importantly support to women when they need it most. We are reporting a variant aplasia cutis congenita, which involved over 90% of the body surface area, which occurred in a baby born to a mother with pemphigus vulgaris who was on oral prednisolone and azathioprine. The entire body was covered in a membrane which had numerous vessels visible on its surface. According to the National Down Syndrome Society, there are more than 350,000 people living with Down syndrome in the United States.
When the egg and the sperm unite to form the fertilized egg, three (rather than two) chromosomes 21 are present.

This is because the extra chromosome 21 material is located on a different chromosome (the translocated one).
Fifteen to thirty percent of women with trisomy 21 are fertile and they have about a 50% risk of having a child with Down syndrome. Then, an ultrasound is used to look at the nuchal translucency region under the skin behind the baby’s neck. Infants born with Down syndrome may be of average size, but grow slowly and remain smaller than other children of the same age. A case of extensive aplasia cutis congenita was seen and oral intake of azathioprine by the mother during pregnancy was suspected as an etiologic factor.
What makes the case interesting is that this neonate was exposed to two drugs in utero, prednisolone before and throughout pregnancy and azathioprine 6 weeks before and for the first 20 weeks of pregnancy.Corticosteroids, prednisone and prednisolone cross the placental barrier, but are metabolized by a placental 11- hydroxygenase and thus the foetus is exposed to only 10% of the maternal dose.
Type 1 although not associated with multiple abnormalities and has only localized lesions on the scalp; but as the investigations were not done, the abnormalities cannot be ruled out.
The parents of the patient did not consent for biopsy or autopsy so the histopathological picture was not available and hence involvement of other systems could not be ascertained. The effects of immunosuppressive drugs and anti-inflammatory medications on fertility, pregnancy, and lactation. In cellular mosaicism, the mixture can be seen in different cells of the same type; while with tissue mosaicism, one set of cells may have normal chromosomes and another type may have trisomy 21.
The carrier will not exhibit any of the symptoms of Down syndrome because they have the correct amount of genetic material.
Due, to financial constraints some of the investigations which might have helped in assigning the patient to a particular category of aplasia cutis such as karyotyping and CT scan brain could not be carried out. Azathioprine and mercaptopurine both cross the placenta and mercaptopurine can be measured in foetal blood. Our patient suffered from isolated extensive ACC and was exposed in utero to both, azathioprine, and prednisolone.
He was nursed in an incubator but died on the 4th day of birth of neonatal sepsis in spite of supportive management, including antibiotic therapy.He was born to non consanguineous parents by lower segment caesarian section at 38 weeks of gestation because the baby showed signs of intrauterine growthretardation. Azathioprine has been held responsible for an increase in congenital malformations although not specifically ACC and prednisolone is regarded safe in pregnancy. Unfortunately our patient could not be investigated extensively due to financial constraints.Our patient had extensive ACC and it appeared to be an isolated finding. So we conclude that our patient is most likely type 8 ACC — as there was no evidence of limb reduction defects, epidermolysis bullosa, intrauterine infection or twin pregnancy, on the other hand, exposure to azathioprine at the time of conception and for the following 20 weeks could be responsible for this occurrence. The mother who was 26 years of age had a history of pemphigus vulgaris for the past 1 year, confirmed on histopathology and direct immunoflourescence. We believe it is important to document this extensive skin aplasia and although a chance occurrence cannot be ruled out, the extensive and severe nature of the defect makes us wary and wonder if azathioprine really is an innocent bystander? Her disease had been particularly difficult to control and she had been on tablet prednisolone 60 mg daily for the first 2 months of pregnancy. The safety of 6-mercaptopurine for childbearing patients with inflammatory bowel disease: a retrospective cohort study.
After delivery of the baby the dose of prednisolone was reduced gradually and her disease was controlled on 15 mg of prednisolone on alternate days.

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