Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Systemic Vasculitis and Pregnancy: Maternal and Neonatal Outcome of 20 Prospectively Followed Pregnancies.

Fredi1,  Micaela, Mosca2,  Marta, Ziglioli1,  Tamara, Tani2,  Chiara, Filippini1,  Matteo, Strigini2,  Francesca, Andreoli1,  Laura

Rheumatology Unit, University of Brescia, Brescia, Italy
University of Pisa, Pisa, Italy
Neonathology and NICU, Spedali Civili, Brescia, Italy
Obstetric and Gynecology of Brescia, Brescia, Italy

Background/Purpose:

The increasing knowledge in diagnosis and management of primary systemic vasculitis (SV) has led to an earlier detection and treatment of such diseases with the consequent improvement of survival rate and quality of life. SV are rare diseases and, unlike other autoimmune conditions, they do not preferentially affect women. Therefore our understanding of the relationship between pregnancy and SV is limited. The aim of this study was to describe pregnancy outcome in patients with diagnosis of SV followed in our Institution; to evaluate the influence of pregnancy on maternal disease.

Methods:

Analysis of 20 pregnancies (prospectively followed by a multispecialistic team) in 15 patients with diagnosis of SV, according to Chapel Hill Consensus Conference and/or ACR Criteria for SV. Two patients were affected by Takayasu arteritis (TA), 3 by Churg-Strauss syndrome (CS), 2 by Polyarteritis nodosa (PA), 8 by Behcet's disease (BD). Data regarding the duration of disease, serological and clinical features, pregnancy outcome, neonatal and maternal complications and therapy during pregnancy were collected from clinical charts.

Results:

All the patients conceived during clinical and serological remission of the disease. The median age of the patients at the conception was 33 (range 27–40); 13 patients were Caucasian, 1 from North Africa and 1 from South America. The mean duration of SV before pregnancy was 8 years (range 1–17). Reproductive history of each patient is detailed in the table. There were 2 miscarriages and 2 fetal death in 2 patients (20% of all pregnancies); 4 pregnancies (20%) had complications: 1 preeclampsia, 3 premature deliveries (before 34 week), 1 post-partum haemorrhage and a post-partum disseminated intravascular coagulation (DIC). Flares of the disease appeared in 5 patients (33,3%): 1 PA, 2 TA and 2 BD. We had 18 live births: 5 premature (28%), in particular 1 newborn small for gestational age (SGA), 1 suffered from necrotizing enterocolitis (NEC) and 1 from respiratory insufficiency.

Conclusion:

Our data show that conceiving during the remission of the disease and strictly monitoring of the pregnancy seem to be not sufficient to prevent flare of the disease, maternal and neonatal complications. In particular we want to emphasize the elevated frequency of preterm delivery before the 34th week among the live births (28% vs 5% of the general obstetric population of our hospital).

Table.

PtDiseaseN° pregnancyOutcomeWeek of delivery or lossMaternal complicationsNeonatal complicationsTreatment
1TA3a) miscarriage b) miscarriage c) live birth (twins)a) 7 b) 8 c)32Flare of the disease 2nd trimester, abruptio placentaeLDA, PDN
2TA1a)live birtha) 38Flare of the disease 3rd trimester, PROMLDA AZA LMWH
3PA limited2a) live birth b) live birtha)38 b)40LDA
4PA systemic1a)live birtha)30Flare of the disease 2nd trimester, preclampsiaSGALDA, PDN, antihypertensive therapy
5CS1a) live birth (twins)a)31Abruptio placentae; post-partum haemorrhage1 with NEC, 1 with RIPDN, asthma therapy
6CS1a)live birtha)39PDN, asthma therapy,
7CS1a)live birtha) 40
8BD1a)live birtha)38Flare of the disease 1st trimester; post partum DICLDA cyclosporine, PDN
9BD1a)live birtha)39LDA
10BD1a)live birtha)38LDA, LMWH
11BD3a) fetal death b) fetal death c) live birtha) 12 b) 15 c)38LDA, LMWH
12BD1a)live birtha)40Flare of the disease 2nd trimesterLDA, M-PD
13BD1a)live birtha)40
14BD1a)live birtha)37PDN, LDA
15BD1a)VIPMMF, LMWH, antihepileptic drug
LDA= low dose aspirin, LMWH= low-molecular-weight heparin, PDN= prednisone, M-PD=methyl prednisolone, MMF= mycophenolate mofetil, NEC= necrotizing enteritis, IR= respiratory insufficency, VIP= voluntary interruption of pregnancy, DIC= disseminated intravascular coagulation, SGA= small for gestational age

To cite this abstract, please use the following information:
Fredi, Micaela, Mosca, Marta, Ziglioli, Tamara, Tani, Chiara, Filippini, Matteo, Strigini, Francesca, et al; Systemic Vasculitis and Pregnancy: Maternal and Neonatal Outcome of 20 Prospectively Followed Pregnancies. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1535
DOI:

Abstract Supplement

Meeting Menu

2011 ACR/ARHP