ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 3070

Outcome of Pregnancies in Patients with Takayasu Arteritis with Special Focus on Risk Factors and Disease Activity

Noemie Abisror1, Arsene Mekinian1, Marc Lambert2, Eric Hachulla3, Robin Dhote4, Catherine Chapelon5, Antoine Néel6, Amar Smail7, Frederic Vandergheynst8, Nihal Martis9, Jean Gabriel Fuzibet10, Françoise Sarrot-Reynauld11, Marc Andre12, Alain Fur13, Francois Maurier14, Julien Haroche15, Bertrand Godeau16,17, Murielle Rondeau18, Frederic Renou19, Pauline Belenotti20, Laure Swiader20, Patrice Cacoub21, Bruno Devaux22, Luc Mouthon23, Jean Baptiste Gaultier24, Pascal Cathebras25, Olivier Pourrat26, Olivier Fain1, Véronique Le Guern27 and Nathalie Costedoat-Chalumeau27, 1Internal Medicine Department, Saint Antoine Hospital, Paris, France, 2CHU Lille, Lille, France, 3Department of Internal Medicine, University Lille Nord-de-France, Lille, France, 4Internal Medicine, Hospital Avicenne, Bobigny, France, 5Department of Internal Medicine 2. Referal center for SLE/APS, CHU Pitié-Salpêtrière, Paris, France, 6Internal Medicine, Nantes University Hospital, Nantes, France, 7Internal Medecine, Amiens Hospital, Amiens, France, 8Internal Medicine, Erasme hospital, Bruxelles, Belgium, 9Internal medicine, Nice, France, 10Internal Medicine, Internal Medicine, Hôpital de l'Archet 1, CHU de Nice, Nice, France, 11Internal medicine, Grenoble, France, 12Internal medicine, Clermont Ferrand, France, 13Internal medicine, Troyes, France, 14HP Metz Belle Isle Hospital, Department of Internal Medicine, Metz, France, 15Internal Medecine, Pitié-Salpêtrière hospital, Paris, France, 16Henri Mondor, Créteil, France, 17Internal Medicine, University of Paris, AP-HP, Hôpital Mondor Créteil, Creteil, France, 18Internal medicine, Strasbourg, France, 19Internal medicine, Saint Denis, France, 20Internal medicine, Marseille, France, 21Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France, 22Internal medicine, Coulommiers, France, 23Paris Descartes University, UPRES-EA 4058, Department of Internal Medicine, Cochin Hospital, Paris, France, 24Internal medicine, Saint Etienne, France, 25Internal Medicine, University Hospital St Etienne, St Etienne, France, 26Internal medicine, Poitiers, France, 27Internal Medicine Department, Cochin Hospital, “René-Descartes Paris V” University, Paris, France

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords:

Session Information

Date: Tuesday, November 10, 2015

Title: Vasculitis Poster III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Takayasu arteritis (TA) is
a large-vessel vasculitis that affects young women of childbearing age. We
aimed to analyze the outcome of pregnancies in TA patients and to identify the
factors associated with maternal and neonatal prognosis.

Methods: We conducted a French nationwide retrospective study of pregnancies
occurring in patients with a TA diagnosis.

Results: Forty-one pregnancies occurred in 31 TA women between 1999 and 2015.
Steroids were used in 25 pregnancies (61%), azathioprine in 9 (22%) and
anti-TNF- agonist in 1 (3%). Nineteen pregnancies (46%) were complicated by at
least one obstetrical adverse event: 14 gravida arterial hypertension (34%)
with 3 pre-eclampsia (7%), 1 HELLP syndrome (2%), 6 intrauterine growth
restriction (15%), and 2 post-partum hemorrhage (5%). Delivery was vaginal in
22 (54%) and by cesarean section in 19 pregnancies (46%).There were 40 live
births (98%) with a median term of 38 [27-42] weeks of gestation with 8
premature birth (20%). The median birth weight was 2985 [1050-4310] grams with
7 neonates <2500 gr (17%). Four children required intensive care units (10%)
and one died at 2 days of life.  Maternal
chronic arterial hypertension increased the risk of gravida arterial
hypertension (p=0.01), of pre-eclampsia (p=0.04) and of cesarean delivery
(p=0.01). The presence of renal artery stenosis before pregnancy increased the
risk of fetal growth restriction (p=0.04). The presence of renal artery
stenosis before pregnancy as well as the presence of infra-diaphragmatic
vasculitis both increased the risk of low birth weight (p=0.03 and p=0.023
respectively).

TA disease
activity was observed in 8 pregnancies (20%), including 2 flares in previously
inactive patients. The risk of flare or of TA activity was higher if TA had
been active in the 6 months before pregnancy: 6 active disease in 10
pregnancies (60%) if TA had been active before pregnancy versus 2 in 31 (6%) if
TA had been inactive (p=0.0011).

Conclusion: We observed a high rate of obstetrical complications
in this large series of pregnancies occurring in patients diagnosed with TA. The presence of chronic hypertension,
infra-diaphragmatic vasculitis, renal artery stenosis or active disease before
pregnancy were associated with poor pregnancy outcome. TA activity did not seem
to be strongly influenced by pregnancy.

Mothers

30

Age at pregnancy, median [range]

30 [22-42]

Parity

Primipara, n (%)

19 (61)

Multipara, n (%)

12 (39)

Treatment during pregnancy

Aspirin 75-100 mg/day, n (%)

25 (61)

Low weight molecular heparin (end of pregnancy), n (%)

8 (20)

Curative anticoagulant therapy, n (%)

1 (3)

Prednisone, n (%)

 25 (61)

Azathioprine, n (%)

9 (22)

Infliximab, n (%)

1 (3)

Antihypertensive drugs, n (%)

9 (22)

Obstetrical complications

19 (46)

Gravida arterial Hypertension, n (%)

14 (34)

Increase of preexisting hypertension, n (%)

11 (27)

De novo hypertension, n (%)

3 (7)

With preeclampsia, n (%)

3 (7)

HELLP syndrome, n (%)

1 (3)

Fetal Growth Restriction, n (%)

6 (15)

Delivery mode, n (%)

Vaginal delivery, n (%)

21 (54)

Cesarean section, n (%)

18 (46)

Post-partum hemorraghe, n (%)

2 (5)

Children

Premature birth, n (%)

8 (20)

Severe premature birth (<34 weeks), n (%)

2 (6)

Full-terme birth, n (%)

32 (78)

Gestational age, median weeks [range]

38 [27-42]

Birth weight, median grams [range]

2985 [1050-4310]

Birth weight < 2500gr, n (%)

7 (17)

Intrauterine death, n (%)

1 (3)

Intensive care unit transfer, n (%)

4 (10)

Perinatal mortality, n (%)

1 (3)

TABLE 2. Forty-one pregnancies: maternal and fetal outcomes

Disclosure: N. Abisror, None; A. Mekinian, None; M. Lambert, None; E. Hachulla, None; R. Dhote, None; C. Chapelon, None; A. Néel, None; A. Smail, None; F. Vandergheynst, None; N. Martis, None; J. G. Fuzibet, None; F. Sarrot-Reynauld, None; M. Andre, None; A. Fur, None; F. Maurier, None; J. Haroche, None; B. Godeau, None; M. Rondeau, None; F. Renou, None; P. Belenotti, None; L. Swiader, None; P. Cacoub, None; B. Devaux, None; L. Mouthon, Roche Pharmaceuticals, 5; J. B. Gaultier, None; P. Cathebras, None; O. Pourrat, None; O. Fain, None; V. Le Guern, None; N. Costedoat-Chalumeau, None.

To cite this abstract in AMA style:

Abisror N, Mekinian A, Lambert M, Hachulla E, Dhote R, Chapelon C, Néel A, Smail A, Vandergheynst F, Martis N, Fuzibet JG, Sarrot-Reynauld F, Andre M, Fur A, Maurier F, Haroche J, Godeau B, Rondeau M, Renou F, Belenotti P, Swiader L, Cacoub P, Devaux B, Mouthon L, Gaultier JB, Cathebras P, Pourrat O, Fain O, Le Guern V, Costedoat-Chalumeau N. Outcome of Pregnancies in Patients with Takayasu Arteritis with Special Focus on Risk Factors and Disease Activity [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/outcome-of-pregnancies-in-patients-with-takayasu-arteritis-with-special-focus-on-risk-factors-and-disease-activity/. Accessed .

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