Pregnancy in women diagnosed with Antineutrophil cytoplasmic antibody–associated vasculitis: Outcome for the mother and the child

Abstract

Objective. Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is infrequently seen in women of childbearing age. Only a limited number of pregnancies in women with AAV have been reported, and often they were associated with complications. Methods. This was a single-center retrospective observational study. All pregnancies in women with granulomatosis with polyangiitis (Wegener's) (n ‫؍‬ 13) and microscopic polyangiitis (n ‫؍‬ 1) were included. Women of childbearing age were counseled to abstain from pregnancy during or shortly after disease activity or <1 year after cyclophosphamide treatment. Results. We described 22 pregnancies in 14 women with AAV (median age at diagnosis was 25 years [range 19 -36 years]) diagnosed between 1982-2008. The ear, nose, and throat region (71%) and kidneys (50%) were predominantly involved. All women were in remission at conception and cyclophosphamide had been administered to 9 women (15 pregnancies). The median gestational age was 39؉4 weeks, including 2 preterm deliveries. The median birth weight was 3,400 gm (1,860 -3,890 gm). Hypothyroidism occurred in 1 newborn and a cleft palate in 1 newborn of a twin pregnancy. Otherwise, the fetal outcome was excellent. Preeclampsia was diagnosed in 2 pregnancies. A caesarean section was performed in 2 patients. The median followup after the last conception was 98 months (range 11-307 months). Eight women experienced a relapse 21 months (range 7-62 months) after conception, 1 during pregnancy, and 7 after delivery. Conclusion. In this study, the pregnancy outcome in patients with AAV in remission was excellent. Pregnancy in women with AAV in remission does not seem to be associated with increased risk of relapse. Counseling, careful management, and close followup are essential in pregnant women with AAV.

Successful treatment outcomes in pregnant patients with ANCA‐associated vasculitides: A systematic review of literature

“…Sixteen participants had 2 pregnancies, 4 had 3 pregnancies and one had 4 pregnancies. The diagnosis was GPA in 78 patients, EGPA in 22 patients, MPA in 9 patients and renal vasculitis in one patient. Data regarding remission were available for 35 pregnancies in 34 patients with median duration of remission prior to pregnancy of 36 months (range, 3‐120 months) (Table ).…”

“…Nine patients received IVIG with good results . Plasma exchange was offered in 10 instances for life‐ or organ‐threatening disease during or before pregnancy …”

Successful outcome of pregnancy in patients with anti-neutrophil cytoplasm antibody–associated small vessel vasculitis

“…6 Only two pre-term deliveries, no pregnancy losses, and one relapse of disease occurred during pregnancy. The disease severity within our cohort is comparable to the Dutch cohort; however, in 14 of the reported Dutch pregnancies women were off treatment at conception and throughout pregnancy.…”

Fetal outcomes after rituximab exposure in women with autoimmune vasculitis

“…Interestingly, in women with anti-neutrophil cytoplasmic autoantibody vasculitis who are in remission after standard induction therapy, pregnancy is not typically associated with relapse and outcomes are excellent. 4 One of our patients had progressive airway disease despite improvement of other disease manifestations; however, remaining patients had no return of disease despite a reduction of immunosuppression. It appears likely that the sole pregnancy with congenital anomalies and associated miscarriage was unrelated to rituximab use.…”