Pregnancy Outcomes Among Patients With Vasculitis

Abstract

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.

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

“…Women who experienced increased disease activity during pregnancy were more likely to deliver pre-term. 7 Recently, a French series reported 19 pregnancies in 11 women following a diagnosis of AAV, and the complication rates reported were higher than those we observed in our cohort. 5 Two of the 14 pregnancies ended in first trimester terminations and four miscarried.…”

“…[1][2][3][4][5] Recent reports have suggested more favorable outcomes 6 with a lower risk of disease relapse but still a high incidence of pregnancy loss and pre-term births. 5,7 We predicted that planned pregnancies in women in sustained clinical remission, maintained on non-teratogenic treatments, would lead to more favorable pregnancy outcomes than those previously reported. Here we report the outcomes of pregnancy in women with AAV at five centers in the United Kingdom.…”

A cross‐sectional multicenter study of osteogenesis imperfecta in North America – results from the linked clinical research centers

“…Whereas the conduct of clinical studies in rare diseases have been uncommon, the improved awareness because of activities by patient advocacy groups, increased funding from the National Institutes of Health (NIH), and escalating interest of the pharmaceutical industry in smaller niche markets have led to a significant increase in rare disease research over the recent years. It is now well‐recognized that collaborative multicenter studies in rare diseases can lead to a better understanding of the natural history of disease, generate hypothesis for further research, identify biomarkers for disease monitoring, and provide better therapeutic options for patients . The Rare Disease Clinical Research Network established under the Office of Rare Disease Research of the NIH is an outstanding example for such collaborative multicenter clinical studies (http://rarediseasesnetwork.epi.usf.edu/).…”

Autoimmune connective tissue diseases

“…Published experience of their course during pregnancy and pregnancy outcome is quite limited and consists frequently of retrospective uncontrolled studies and case reports [16,17]. General statements on their interaction with pregnancy are difficult to make.…”