Pregnancy-Related Complications in Patients With Fibromuscular Dysplasia

Abstract

Current literature suggests a higher risk of pregnancy-related complications in patients with renal fibromuscular dysplasia (FMD). The aim of our study was to assess the nature and prevalence of pregnancy-related complications in patients subsequently diagnosed with FMD. A call for participation was sent to centers contributing to the European/International FMD Registry. Patients with at least 1 pregnancy were included. Data on pregnancy were collected through medical files and FMD characteristics through the European/International FMD Registry. Data from 534 pregnancies were obtained in 237 patients. Despite the fact that, in 96% of cases, FMD was not diagnosed before pregnancy, 40% of women (n=93) experienced pregnancy-related complications, mostly gestational hypertension (25%) and preterm birth (20%), while preeclampsia was reported in only 7.5%. Only 1 patient experienced arterial dissection and another patient an aneurysm rupture. When compared with patients without pregnancy-related complications, patients with complicated pregnancies were younger at FMD diagnosis (43 versus 51 years old; P <0.001) and had a lower prevalence of cerebrovascular FMD (30% versus 52%; P =0.003) but underwent more often renal revascularization (63% versus 40%, P <0.001). In conclusion, the prevalence of pregnancy-related complications such as gestational hypertension and preterm birth was high in patients with FMD, probably related to the severity of renal FMD. However, the prevalence of preeclampsia and arterial complications was low/moderate. These findings emphasize the need to screen hypertensive women for FMD to ensure revascularization before pregnancy if indicated and appropriate follow-up during pregnancy, without discouraging patients with FMD from considering pregnancy.

Prevalence and Disease Spectrum of Extracoronary Arterial Abnormalities in Spontaneous Coronary Artery Dissection

“…In patients with SCAD and FMD, the prevalence of FMD in multiple vascular beds (multivessel FMD) was 29.1%, consistent with that documented by Prasad et al 7 (29%), but lower than in previous SCAD studies by Saw et al 8 (49%) and Liang et al 22 (44%), as well as in patients with primary FMD included in large registries (57%-66%). 9,10, 16,17,19 Similarly, in this series of patients with SCAD, the prevalence of arterial aneurysms (7.5%) and dissections (1.7%) was much lower than that reported in registries of primary FMD (aneurysms: 21.6%-26.0%; dissections: 5.6%-28.1%). [16][17][18] In addition, although arterial tortuosity is considered a manifestation of primary FMD, 9,10 in our series of patients with SCAD, whether in the presence or absence of FMD, the prevalence of extracoronary arterial tortuosity was not higher than in healthy controls.…”

“…9,10, 16,17,19 Similarly, in this series of patients with SCAD, the prevalence of arterial aneurysms (7.5%) and dissections (1.7%) was much lower than that reported in registries of primary FMD (aneurysms: 21.6%-26.0%; dissections: 5.6%-28.1%). [16][17][18] In addition, although arterial tortuosity is considered a manifestation of primary FMD, 9,10 in our series of patients with SCAD, whether in the presence or absence of FMD, the prevalence of extracoronary arterial tortuosity was not higher than in healthy controls. In view of similar performance of MRA and CTA in 43 patients explored by both imaging modalities, these findings are unlikely to be explained by a lesser sensitivity of MRA vs CTA for detection of clinically relevant lesions.…”

“…23 Our findings lend further support to the concept that SCAD with FMD and primary FMD may correspond to distinct although overlapping entities. Along the same lines, dissections in patients with FMD are associated with the male sex 17,18,24,25 and patients with SCAD are primarily female. Also, recent studies report only a partial overlap between genetic determinants of FMD and SCAD.…”

“…However, the demographic and SCAD-related characteristics in our series are in line with those reported in other large SCAD cohorts. 7,21,28 Second, the comparison of the prevalence of multivessel FMD, aneurysms, and dissections with that reported in registries focused on patients with primary FMD [16][17][18][19] needs to be considered with caution. Indeed, in the latter, with the exception of the Assessment of Renal and Cervical Artery Dysplasia study, 16 whole body scanning was not performed in all patients.…”

Fibromuscular dysplasia: its various phenotypes in everyday practice in 2021

“…Patients who have undergone revascularization procedures may require more frequent imaging surveillance [3]. Pregnant women with FMD also require more intensive follow up, especially those with renal FMD because of an increased risk of gestational hypertension, preterm birth and, to a lesser extent preeclampsia, and those with known aneurysms, because of increased rupture risk [3,17,18].…”