Pregnancy outcomes in women with primary systemic vasculitis: a retrospective study

Nguyen, Vanessa; Wuebbolt, Danielle; Pagnoux, Christian; D’Souza, Rohan

doi:10.1080/14767058.2019.1671329

Cited by 17 publications

(19 citation statements)

References 17 publications

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“…Disease activity in pregnancy varies by diagnosis, but all females with vasculitis should be considered for thromboprophylaxis during pregnancy. Pregnancy in these patients is associated with increased prevalence of pregnancy complications, especially pregnancy loss and preeclampsia; 63 however, improved disease control prior to conception can improve outcomes. 64 Patients with a new diagnosis or active disease prior to pregnancy are at higher risk of flares during pregnancy.…”

Section: Vasculitismentioning

confidence: 99%

Management of Pregnancy in Rheumatic Disease

Maguire

O’Shea

2021

EMJ Rheumatol

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Managing patients with rheumatic diseases (RMD) during pregnancy and the postpartum period can be a challenge for both rheumatologists and obstetricians. While disease activity during the course of pregnancy varies with regard to the presence of underlying conditions, maintenance of remission from conception through to delivery increases the chances of an uncomplicated pregnancy. A period of remission of at least 6 months prior to conception increases the chance of a successful conception while decreasing the risk of flares during pregnancy. For this reason, discussion of pregnancy in females with RMDs should begin prior to conception with risk stratification and pregnancy planning. This allows for the transfer to pregnancy-compatible medications, disease stabilisation, determination of autoantibody status, and evaluation of end-organ damage. During pregnancy, where possible, disease activity should be monitored with scores modified to allow use in pregnancy. Prompt recognition and treatment of active disease is essential to minimise the risk to the pregnancy. Systemic lupus erythematosus and axial spondyloarthropathy can present diagnostic dilemmas due to overlap of symptoms of disease activity and normal pregnancy. Patients with end-organ involvement, such as systemic lupus erythematosus or systemic sclerosis, face a higher risk of adverse pregnancy outcomes and disease progression. Close monitoring of patients with RMD should be done by both obstetrics and rheumatology, with regular communication between specialties. Medications should be reviewed at each stage of pregnancy to ensure compliance with the current American College of Rheumatology (ACR) guidelines and the adequate treatment of RMDs.

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Section: Vasculitismentioning

confidence: 99%

Management of Pregnancy in Rheumatic Disease

Maguire

O’Shea

2021

EMJ Rheumatol

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Section: Introductionmentioning

confidence: 99%

“…The literature search revealed 133 pregnancies in women with AAV, evincing a higher rate of pre-term birth and IUGR compared to the general obstetric population ( Dalakas, 2011 ; Gatto et al, 2012 ; Tuin et al, 2012 ; Nguyen et al, 2021 ). Women with active disease during gestation are at highest risk of both fetal and maternal complications ( Gatto et al, 2012 ; Tuin et al, 2012 ; Fredi et al, 2015 ; Nguyen et al, 2021 ). Among patients with systemic vasculitides, women with AAV present the highest rate of relapse: most commonly flares -largely of non severe nature- supervene in the third trimester, invariably in case of active disease at the time of conception ( Fredi et al, 2015 ; Nguyen et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…Women with active disease during gestation are at highest risk of both fetal and maternal complications ( Gatto et al, 2012 ; Tuin et al, 2012 ; Fredi et al, 2015 ; Nguyen et al, 2021 ). Among patients with systemic vasculitides, women with AAV present the highest rate of relapse: most commonly flares -largely of non severe nature- supervene in the third trimester, invariably in case of active disease at the time of conception ( Fredi et al, 2015 ; Nguyen et al, 2021 ). Reports describing obstetric outcome in AAV women do not provide data on complement levels, possibly due to the only recent interest devoted to complement system in this setting.…”

Section: Introductionmentioning

confidence: 99%

“…The most common obstetric complications observed in women with Takayasu arteritis relate to severe hypertension and preeclampsia, which are associated with intrauterine fetal death and IUGR. Pregnancy does not seem to impact on disease activity: inflammation even attenuates during gestation, and flares during pregnancy are rare events ( Hirayama et al, 2015 ; Nguyen et al, 2021 ; Gatto et al, 2012 ; Fredi et al, 2015 ; Chen et al, 2021 ; Hidaka et al, 2012 ; Tanaka et al, 2014 ; Alpay-Kanitez et al, 2015 ; Mandal et al, 2012 ; Comarmond et al, 2015 ; de Jesús et al, 2012 ; Singh N. et al, 2015 ). The complement system has not been evaluated in pregnant women with Takayasu arteritis.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Beyond Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome: The Relevance of Complement From Pathogenesis to Pregnancy Outcome in Other Systemic Rheumatologic Diseases

et al. 2022

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Evidence about the relevance of the complement system, a highly conserved constituent of the innate immunity response that orchestrates the elimination of pathogens and the inflammatory processes, has been recently accumulated in many different rheumatologic conditions. In rheumatoid arthritis, complement, mainly the classical pathway, contributes to tissue damage especially in seropositive subjects, with complement activation occurring in the joint. Data about complement pathways in psoriatic arthritis are dated and poorly consistent; among patients with Sjögren syndrome, hypocomplementemia exerts a prognostic role, identifying patients at risk of extra-glandular manifestations. Hints about complement involvement in systemic sclerosis have been recently raised, following the evidence of complement deposition in affected skin and in renal samples from patients with scleroderma renal crisis. In vasculitides, complement plays a dual role: on one hand, stimulation of neutrophils with anti-neutrophil cytoplasmic antibodies (ANCA) results in the activation of the alternative pathway, on the other, C5a induces translocation of ANCA antigens, favouring the detrimental role of antibodies. Complement deposition in the kidneys identifies patients with more aggressive renal disease; patients with active disease display low serum levels of C3 and C4. Even though in dermatomyositis sC5b-9 deposits are invariably present in affected muscles, data on C3 and C4 fluctuation during disease course are scarce. C3 and C1q serum levels have been explored as potential markers of disease activity in Takayasu arteritis, whereas data in Behçet disease are limited to in vitro observations. Pregnancies in women with rheumatologic conditions are still burdened by a higher rate of pregnancy complications, thus the early identification of women at risk would be invaluable. A fine-tuning of complement activation is required from a physiological progression of pregnancy, from pre-implantation stages, through placentation to labour. Complement deregulation has been implicated in several pregnancy complications, such as recurrent abortion, eclampsia and premature birth; low complement levels have been shown to reliably identify women at risk of complications. Given its physiologic role in orchestrating pregnancy progression and its involvement as pathogenic effector in several rheumatologic conditions, complement system is an attractive candidate biomarker to stratify the obstetric risk among women with rheumatologic conditions.

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Neues zu seltenen rheumatologischen Erkrankungen in der Schwangerschaft

Henes

Pecher

2021

Z Rheumatol

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Pregnancy outcomes in women with primary systemic vasculitis: a retrospective study

Cited by 17 publications

References 17 publications

Management of Pregnancy in Rheumatic Disease

Management of Pregnancy in Rheumatic Disease

Beyond Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome: The Relevance of Complement From Pathogenesis to Pregnancy Outcome in Other Systemic Rheumatologic Diseases

Neues zu seltenen rheumatologischen Erkrankungen in der Schwangerschaft

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