Systemic vasculitis and pregnancy: A multicenter study on maternal and neonatal outcome of 65 prospectively followed pregnancies

Fredi, Micaela; Lazzaroni, Maria Grazia; Tani, Chiara; Ramoni, Vèronique; Gerosa, Maria; Inverardi, F.; Sfriso, Paolo; Caramaschi, Paola; Andréoli, Laura; Sinico, Renato Alberto; Motta, Mario; Lojacono, Andrea; Trespìdi, Laura; Strigini, Francesca Anna Letizia; Brucato, Antonio; Caporali, Roberto; Doria, Andrea; Guillevin, Loı̈c; Meroni, Pier Luigi; Montecucco, Carlomaurizio; Mosca, Marta; Tincani, Anǵela

doi:10.1016/j.autrev.2015.03.009

Cited by 52 publications

(54 citation statements)

References 32 publications

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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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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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“…As mentioned, a sustained clinical remission before conception has been noted to significantly improve maternal and fetal outcomes in women with both lupus nephritis (19,20) and vasculitis (30), and active nephritis is associated with higher rates of preeclampsia, increased premature delivery, small for gestational age births, and accelerated loss of renal function (2,44). From this, we deduce that any active GN will potentially contribute to adverse pregnancy outcomes, and control of the glomerular disease with pregnancy-safe immunosuppression is desirable, whereas all potentially teratogenic medications must be discontinued.…”

Section: Prepregnancy Carementioning

confidence: 90%

Pregnancy and Glomerular Disease

Blom

Odutayo

Bramham

et al. 2017

CJASN

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During pregnancy, CKD increases both maternal and fetal risk. Adverse maternal outcomes include progression of underlying renal dysfunction, worsening of urine protein, and hypertension, whereas adverse fetal outcomes include fetal loss, intrauterine growth restriction, and preterm delivery. As such, pregnancy in young women with CKD is anxiety provoking for both the patient and the clinician providing care, and because the heterogeneous group of glomerular diseases often affects young women, this is an area of heightened concern. In this invited review, we discuss pregnancy outcomes in young women with glomerular diseases. We have performed a systematic review in attempt to better understand these outcomes among young women with primary GN, we review the studies of pregnancy outcomes in lupus nephritis, and finally, we provide a potential construct for management. Although it is safe to say that the vast majority of young women with glomerular disease will have a live birth, the counseling that we can provide with respect to individualized risk remains imprecise in primary GN because the existing literature is extremely dated, and all management principles are extrapolated primarily from studies in lupus nephritis and diabetes. As such, the study of pregnancy outcomes and management strategies in these rare diseases requires a renewed interest and a dedicated collaborative effort.

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“…Hypothyroidism, which has been associated with various pregnancy complications, 115 Decreased levels of anti-TPO led to better outcomes and decreased rates of miscarriages. [124][125][126][127][128][129] Perhaps the most well known is the association between vitamin D deficiency and SLE. [124][125][126][127][128][129] Perhaps the most well known is the association between vitamin D deficiency and SLE.…”

Section: How Vitamin D Impacts the Association Between Autoimmune Dmentioning

confidence: 99%

Vitamin D, autoimmunity and recurrent pregnancy loss: More than an association

Sharif

Watad

et al. 2018

American J Rep Immunol

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Recurrent pregnancy loss (RPL) affects close to 1% of couples; however, the etiology is known in only about 50% of the cases. Recent studies show that autoimmune dysregulation is a probable cause of RPL, which in some cases may be overlooked. In order for a pregnancy to proceed to term, early modulation of immunologic response is required to induce tolerance to the semi-allogenic fetus. Certain subsets of both the innate and adaptive immune responses play a role in the induction of fetomaternal tolerance. A relatively predominant T-cell helper (Th) 2 and T regulatory (Treg) cell population seem to favor a better pregnancy outcome, whereas Th1 and Th17 cell populations appear to have an opposite effect. Lately, the role of vitamin D in the modulation of immune response was established. Vitamin D has been shown to promote a more favorable environment for pregnancy through various mechanisms, such as enhancement of the shift toward Th2 cells and regulation of immune cell differentiation and cytokine secretion. Therefore, it seems that vitamin D deficiency sways the balance toward a worse outcome and may play a part in recurrent pregnancy loss. This review sheds light on the immunologic changes, which occur in early pregnancy and the regulatory role vitamin D has in the maintenance of this delicate balance.

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Systemic vasculitis and pregnancy: A multicenter study on maternal and neonatal outcome of 65 prospectively followed pregnancies

Cited by 52 publications

References 32 publications

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

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

Pregnancy and Glomerular Disease

Vitamin D, autoimmunity and recurrent pregnancy loss: More than an association

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