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 34^th week among the live births (28% vs 5% of the general obstetric population of our hospital).

Table.

Pt	Disease	N° pregnancy	Outcome	Week of delivery or loss	Maternal complications	Neonatal complications	Treatment
1	TA	3	a) miscarriage b) miscarriage c) live birth (twins)	a) 7 b) 8 c)32	Flare of the disease 2nd trimester, abruptio placentae	—	LDA, PDN
2	TA	1	a)live birth	a) 38	Flare of the disease 3rd trimester, PROM	—	LDA AZA LMWH
3	PA limited	2	a) live birth b) live birth	a)38 b)40	—	—	LDA
4	PA systemic	1	a)live birth	a)30	Flare of the disease 2nd trimester, preclampsia	SGA	LDA, PDN, antihypertensive therapy
5	CS	1	a) live birth (twins)	a)31	Abruptio placentae; post-partum haemorrhage	1 with NEC, 1 with RI	PDN, asthma therapy
6	CS	1	a)live birth	a)39	—	—	PDN, asthma therapy,
7	CS	1	a)live birth	a) 40	—	—	—
8	BD	1	a)live birth	a)38	Flare of the disease 1st trimester; post partum DIC	—	LDA cyclosporine, PDN
9	BD	1	a)live birth	a)39	—	—	LDA
10	BD	1	a)live birth	a)38	—	—	LDA, LMWH
11	BD	3	a) fetal death b) fetal death c) live birth	a) 12 b) 15 c)38	—	—	LDA, LMWH
12	BD	1	a)live birth	a)40	Flare of the disease 2nd trimester	—	LDA, M-PD
13	BD	1	a)live birth	a)40	—	—	—
14	BD	1	a)live birth	a)37	—	—	PDN, LDA
15	BD	1	a)VIP	—	—	—	MMF, 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:

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