Update on pregnancy in Takayasu arteritis—A narrative review

Abstract

Takayasu arteritis (TA) is a chronic, idiopathic large‐vessel vasculitis that affects women of reproductive age, and has significant maternal and fetal implications. Although there are contrasting data on the effect of TA on fertility, most studies have shown that fertility outcomes remain unaffected. The disease activity of TA usually either remains stable or decreases during pregnancy. The important fetomaternal complications are maternal hypertension, pre‐eclampsia, prematurity, and intrauterine growth restriction. To reduce maternal and fetal morbidity, controlling the disease before conception is important. This review article discusses the various implications, challenges, and medical and endovascular management of TA during pregnancy.

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

“…Recent evidence support that pregnant women with TA are at increased risk of hypertension, miscarriage and intrauterine growth restriction (IUGR) neonates with this excess risk to be associated with high disease activity during conception 8 . On the other hand, observations suggest that TA tends to remain stable or improve during pregnancy, once conception was achieved during period of low disease activity 9 . However, the precise effect of TA on pregnancy outcomes compared to the general population has not been assessed in a systematic, holistic approach.…”

Takayasu arteritis in peripartum period—A clinical paradox

“…The disease has been attributed to various causes such as genetics, infections (namely, Mycobacterium tuberculosis), and autoimmune, although the exact etiopathogenesis is still unknown. 1 The result of the process is vessel wall inflammation and chronic fibrosis with the formation of inflammatory aneurysms 4 and eventually, stenosis and thrombosis of affected arteries, 5 which gives rise to symptoms of ischemia.…”

“… 2 Vascular damage of TA combined with the normal physiological changes in hemodynamics during pregnancy can act as a catalyst for adverse maternal and fetal outcomes. 5 The most common complication is hypertension in the form of gestational hypertension, preeclampsia, or eclampsia, though different studies show varying percentages. Vessel involvement is likely to reflect on the dynamics between TA and pregnancy as fetal complications such as IUGR and oligohydramnios are associated with renal artery stenosis, due to increased renin activity and resultant elevation of blood pressure and uteroplacental insufficiency.…”

“…Coming to the effect of TA on pregnancy, various studies report different outcomes of pregnancy in patients with TA, but the majority of them worldwide and in India found that obstetric complications are highly likely and are higher in pregnancies after the diagnosis of TA was made than in those before its diagnosis 2 . Vascular damage of TA combined with the normal physiological changes in hemodynamics during pregnancy can act as a catalyst for adverse maternal and fetal outcomes 5 . The most common complication is hypertension in the form of gestational hypertension, preeclampsia, or eclampsia, though different studies show varying percentages.…”

Current Diagnosis and Management of Takayasu Arteritis

“…46,48,50) The rate of remission induction in TAK patients for MTX, AZA and MMF was 81%, 76.7% and 90.0% respectively. 34,38,39) Conventional DMARDs when compared, most were equivalent, except for LEF which had potentially better benefits against CYC in observational stud-ies. 2) Biological agents: Table V summarises biological agents that have been used in TAK.…”