Pregnancy Outcomes in Systemic Vasculitides

Abstract

Purpose of Review In recent years, improvements in the recognition of primary vasculitides and increased treatment options have led to greater survival rates and a better quality of life for patients. Therefore, pregnancy in women with vasculitis has become a more frequent consideration or event. Literature on pregnancy outcomes in this population has grown and allowed us, in this article, to review the effects of pregnancy on disease activity, as well as maternal and fetal outcomes for each type of vasculitides. Recent Findings Successful pregnancies in patients with vasculitides are possible, especially when conception is planned, and the disease is in remission. The risk of vasculitis flare is highly dependent on the type of vasculitis, but overall limited. The most frequent complication associated with large-vessel vasculitis (mainly Takayasu arteritis) is hypertension and preeclampsia. Preterm deliveries and intrauterine growth restriction occur more frequently with small-and medium-vessel vasculitis. Summary Pregnancies in patients with vasculitis should be considered high risk and followed by a multidisciplinary team with expertise in the field. Flares should be managed as in the non-pregnant population, while avoiding medications with unknown safety in pregnancy or known teratogens. Although commonly prescribed for the prevention of preeclampsia, there is limited evidence supporting the use of low-dose aspirin for pregnant women with vasculitis. Prospective registries or studies are needed, to better assess the value of aspirin, the place and long-term impact of new biologics and, to identify predictors of pregnancy outcomes other than disease status at conception.

Clinical Characteristics and Outcomes of Mexican Patients With Behçet’s Syndrome

“…Prior reports in women with BS have described the outcomes during pregnancy, including improvement of the disease in 60% of patients and worsening in 30% during pregnancy, no clear association with preeclampsia, a rate of miscarriages between 7% and 25%, a risk of preterm deliveries between 12% and 25%, an increased risk of thromboembolic events during the postpartum period, and a risk of fetal deaths of <3%. 28 The cause of death in the present cohort was severe infections, similar to the other types of systemic vasculitis. Additional cohorts of BS patients have reported a 1-and 10-year mortality of 0.9% and 3.9%, respectively, and a frequency of infections of 5.4%, with bacterial urinary tract infections being the most frequent.…”

Pregnancy outcomes in Takayasu arteritis patients: a systematic review and meta-analysis

“…Better understanding of the pathophysiologic mechanisms and the expansion of therapeutic choices have resulted in efficient control of the disease, including lower rates of irreversible tissue damage, better quality of life and increased life expectancy 5,6 . Despite such advances, pregnancy in such patients is still considered as high risk and requires special management and follow up 7 .…”

Optimal management of ANCA-associated vasculitis before and during pregnancy: current perspectives

“…In our own ongoing pregnancy registry for patients with rheumatic diseases, we regarded the most recent cases (n = 5 in the last 5 years out of the current 416 pregnancies, we are currently taking care of) of pregnancies in women with AAV (data only partly published) [36]. Their median age was 31 (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) years, two suffered from GPA, two from EGPA and one from MPA and only two pregnancies were planned. In one patient who took leflunomide until unexpected conception the foetus suffered from trisomy 18 and the mother decided for interruption.…”