Pregnancy outcome in patients with systemic vasculitis: a single-centre matched case-control study

Sangle, Shirish; Vounotrypidis, Periklis; Briley, Annette; Nel, Louise; Lutalo, Pamela; Sánchez-Fernández, Simón; Chaib, Ahlem; Salas-Manzanedo, Veronica; Shennan, Andrew; Khamashta, Munther A.; D’Cruz, David

doi:10.1093/rheumatology/kev018

Cited by 35 publications

(21 citation statements)

References 11 publications

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“…Two reports have somewhat disparate results: one reported a pregnancy loss rate of 45.7% among 35 pregnancies and the other reported a pregnancy loss rate of 22% among 22 pregnancies. Preterm birth was a frequent occurrence in both cohorts, with half of the live births being delivered before 37 weeks of gestation and both studies reporting a high level of vasculitis activity (). Other publications have presented only isolated cases.…”

Section: Discussionmentioning

confidence: 96%

Pregnancy Outcomes Among Patients With Vasculitis

Clowse

Richeson

Pieper

et al. 2013

Arthritis Care & Research

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Objective Pregnancy outcomes of patients with vasculitis are unknown, but are of great concern to patients and physicians. Through an online survey, this study assessed pregnancy outcomes among patients with vasculitis. Methods Participants in the Vasculitis Clinical Research Consortium Patient Contact Registry were invited to respond to an anonymous, internet-based survey that included questions about pregnancy outcomes, the timing of pregnancy relative to a diagnosis of vasculitis, and medication use. Results A total of 350 women and 113 men completed the survey. After a diagnosis of vasculitis, 74 pregnancies were reported by women and 18 conceptions were reported by men. The rate of pregnancy loss was higher among women who conceived after a diagnosis of vasculitis compared to those who conceived prior to diagnosis (33.8% versus 22.4%; P = 0.04). Among women, the rate of preterm births increased significantly for pregnancies conceived after a diagnosis of vasculitis relative to those conceived before diagnosis (23.3% versus 11.4%; P = 0.03). Only 18% of women reported worsening of vasculitis during pregnancy, but those who experienced increased vasculitis activity were more likely to deliver preterm. Exposure to cyclophosphamide or prednisone did not appear to impact pregnancy outcomes; however, the number of pregnancies among women taking these medications was small. Among the pregnancies conceived by men with vasculitis, the timing of diagnosis had no significant effect on the rate of pregnancy loss. Conclusion Women who conceived after a diagnosis of vasculitis had a higher rate of pregnancy loss than those who conceived prior to diagnosis. Vasculitis did not worsen during the majority of pregnancies conceived after diagnosis.

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Section: Discussionmentioning

confidence: 96%

Pregnancy Outcomes Among Patients With Vasculitis

Clowse

Richeson

Pieper

et al. 2013

Arthritis Care & Research

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“…To the best of our knowledge, all other published studies examining pregnancy outcomes within the last 20 years in patients with glomerular disease focused on a single glomerular disease subtype, with control populations comprised of healthy women who became pregnant [24,25] or women with the same glomerular disease subtype who did not become pregnant [26,27,28]. For example, a systemic review of 4 studies including 273 patients with IgAN who became pregnant and 241 with IgAN who did not become pregnant compared renal outcomes between these groups [28].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes in Patients with Glomerular Disease Attending a Single Academic Center in North Carolina

et al. 2017

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Background: Contemporary data regarding pregnancy outcomes in US patients with primary glomerular diseases are lacking. We aimed to report fetal and maternal outcomes among women with biopsy-proven primary glomerular disease who received obstetric care at a single large academic US center. Methods: All women with a biopsy-confirmed primary glomerular disease diagnosis and without end-stage kidney disease who received obstetric care at the University of North Carolina (UNC) Hospitals (1996-2015) were identified using the Glomerular Disease Collaborative Network registry and the UNC Hospitals Perinatal Database. The primary study outcome was perinatal death (stillbirth at >20 weeks or neonatal death). Secondary outcomes included premature birth (<37 weeks), birth weight, preeclampsia, and kidney function changes (postpartum vs. baseline). Demographics, clinical characteristics, and outcomes were compared across glomerular disease subtypes. Results: Among 48 pregnancies in 43 women (IgA nephropathy n = 17, focal segmental glomerulosclerosis [FSGS] n = 16, membranous nephropathy n = 6, minimal change disease n = 4), 13% of pregnancies resulted in perinatal death and 48% of babies were born prematurely. From a maternal perspective, 33% of pregnancies were complicated by preeclampsia, 39% by a doubling of urinary protein, and 27% by a ≥50% increase in serum creatinine. Outcome differences across glomerular disease subtypes were not statistically significant, although decline in kidney function appeared most frequent in FSGS. Conclusion: Adverse pregnancy outcomes are frequently observed in women with glomerular disease. The independent influence of glomerular disease subtype on outcomes requires further study. More widespread reporting and analysis of pregnancy outcomes in women with glomerular disease are urgently needed.

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“…3,4 However, during pregnancy, MS can improve in terms of the relapse rate, especially in the third trimester, 2 whereas Behҫet's disease can become worse in more than half of cases. However, there were some conflicting findings for this diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Disease activity of MS and Behҫet's disease worsens in the first 3 months after delivery. 3,4 However, during pregnancy, MS can improve in terms of the relapse rate, especially in the third trimester, 2 whereas Behҫet's disease can become worse in more than half of cases. Third, the present patient was homozygous for HLA-B*51 (HLA-B*51:01), which is the strongest genetic risk factor for Behҫet's disease.…”

Section: Discussionmentioning

confidence: 99%

Case of central nervous system inflammatory disease in late pregnancy

Isobe

Baba

Nakamura

et al. 2019

Clinical & Exp Neuroim

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Background During pregnancy, dynamic changes occur not only in coagulation, but also in immune responses. We report a case of a patient who developed an inflammatory disease in the central nervous system during late pregnancy and was challenging to diagnose. Case presentation A 27-year-old woman experienced dysarthria during pregnancy at approximately 33 gestational weeks. From the 38th week of pregnancy, she developed general fatigue, clumsiness of the left hand and numbness of the right side of the body. After delivery of her child at 41 weeks' gestation, she was moved to the neurology ward for further investigation. She showed limb ataxia of the left extremities and sensory disturbance on the right side of the body, including the face. Magnetic resonance imaging detected multiple gadolinium-enhanced lesions at the brainstem and cerebrum. High-dose intravenous methylprednisolone pulse therapy was effective, but her symptoms still remained, including palatal myoclonus. Diagnosing this patient was challenging, but clinically isolated syndrome or multiple sclerosis and neuro-Behҫet's disease were the main candidates.Conclusions We present a case of a pregnant woman who developed brain inflammatory lesions with unknown etiology. Longitudinal follow up is mandatory for diagnosis with careful tapering of oral prednisolone.

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Pregnancy outcome in patients with systemic vasculitis: a single-centre matched case-control study

Abstract: Patients with SV had a lower median gestational age, but customized birth weights were similar to those of healthy women. Women with SV may flare during pregnancy and the post-partum period and may experience significant pregnancy morbidity.

Cited by 35 publications

References 11 publications

Pregnancy Outcomes Among Patients With Vasculitis

Pregnancy Outcomes Among Patients With Vasculitis

Pregnancy Outcomes in Patients with Glomerular Disease Attending a Single Academic Center in North Carolina

Case of central nervous system inflammatory disease in late pregnancy

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