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 Godeau^16,17, 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: Takayasu.s arteritis and pregnancy

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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