Background/Purpose: ANCA-Associated Vasculitis (AAV) is a small-vessel vasculitis that predominantly affects the kidneys, lungs, and sinuses, among other organs. It has been traditionally associated with older populations, but its occurrence in younger, potentially childbearing, females is increasingly being recognized. In this study, we characterize the outcomes of pregnancy in ANCA-associated vasculitis at a large tertiary care and referral center.

Methods: We performed a retrospective chart review of all patients at the University of Iowa Hospitals and Clinics with a positive PR3 or MPO and a documented diagnosis of vasculitis between 2000 and 2017. Inclusion criteria included female sex and age younger than 45. Charts were reviewed to identify disease activity, clinical manifestations, medication regimens, and pregnancy outcomes.

Results: 24 patients met the inclusion criteria, of which 11 were pregnant at some point, accounting for 29 total pregnancies. Among these, 8 had at least one pregnancy after the diagnosis of AAV and 5 before the diagnosis.

Of those who were pregnant after the diagnosis of AAV, all had single pregnancies. They accounted for 16 pregnancies, of which 7 were viable, 2 are currently gravid, and 7 resulted in spontaneous abortions.

Among the 8 with a preexisting diagnosis of AAV, the mean age was 29 (age range: 22-34 years). Six patients (75%) were MPO positive while 2 (25%) were PR3 positive. All were in remission at conception.

Two patients were on moderate doses of prednisone (15mg – 20mg daily) throughout pregnancy; maintenance immunosuppressive therapy was held for the others. For induction therapy, 5 had cyclophosphamide, 1 had rituximab, and 2 had limited disease not requiring induction therapy.

In vitro fertilization was documented in only 1 patient. Four were delivered by Caesarean section. All 7 who have completed pregnancy experienced complications, including premature birth (4), preeclampsia (2), preterm premature rupture of membranes (1), and cholestasis of pregnancy (1). None experienced a relapse in disease activity during pregnancy, although one patient required tracheostomy for preexisting subglottic stenosis at 11 weeks.

Conclusion: Women with AAV should be considered at high risk for pregnancy complications due to the underlying disease and chronic immunosuppressive treatment regimens. With counseling and very close clinical monitoring, women with AAV may be able to conceive and give birth.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-of-pregnancy-complicated-by-anca-associated-vasculitis-a-retrospective-review/