Background/Purpose: IgA vasculitis (IgA-V) is a systemic vasculitis involving small vessels, most frequently affecting children. There is few information about pregnancy outcomes in women with history of IgA-V and no data regarding placental findings in these pregnancies. The aim of this study is to compare vasculitic, maternal and fetal outcomes, and placental findings in pregnant patients with IgA-V and healthy patients.

Methods: We conducted a retrospective case-control study in a single third level center in Mexico City. We included pregnant women and prior IgA-V diagnosis (cases), with placental histopathology available. Control group included healthy pregnant patients matched by age, number of pregnancies, number of fetuses, BMI and smoking status. Placental findings were categorized per the 2016 Amsterdam Working Group: 1) Maternal vascular malperfusion (MVM), 2) fetal vascular malperfusion (FVM), 3) inflammation/infection, and 4) villitis of unknown etiology.

Results: We analyzed 20 pregnancies in patients with history of IgA vasculitis and 60 matched controls. The median age at IgA-V diagnosis was 12.0 [IQR 7.5, 15.5] years and mean age at gestation was 25.10 ± 4.90 years. During pregnancy two patients (10%) flared, presenting cutaneous manifestations. No differences were observed in hypertensive disorders of pregnancy (5% vs 6.7%; p=0.99), gestational diabetes (0% vs 3.3%; p=0.99), preterm delivery (mean gestational age at birth 38.83 ± 0.99 vs 38.49 ± 2.16; p=0.50), fetal growth restriction (15% vs 5%; p=0.16), stillbirth (0% vs 1.7%; p=0.99), NICU admission (5% vs 6.8%; p=0.99) and perinatal death (5% vs 1.7%; p=0.44). Placental weight averaged 443.62 ± 85.61 grams in IgA-V group, similar to control group (p=0.45). Maternal vascular malperfusión (45% vs 36.7%; p=0.599) and fetal vascular malperfusion (40% vs 23%; p=0.16) were the main placental findings in both groups.

Conclusion: Women with a history of IgA-V have favourable maternal and fetal outcomes, similar to the healthy population matched by age. Placental findings, such as MVM and FVM, were not more frequent in patients with IgA-V.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-outcomes-and-placental-findings-in-women-with-iga-vasculitis-a-case-control-study/