Background/Purpose: Systemic vasculitides are rare, heterogeneous, inflammatory disorders associated with high morbidity and mortality. Recent management and therapeutic advances have improved life expectancy and reproductive opportunities for vasculitis patients. Research on the risk of preterm delivery and maternal complications in these patients is limited. Therefore, we investigated pregnancy outcomes among patients with vasculitis leveraging large, administrative claims data.

Methods: Using administrative claims data from private health insurance providers we identified all pregnancies regardless of outcome for patients with and without vasculitis from 2007 to 2021. Vasculitis was defined as ≥2 ICD coded outpatient visits or ≥1 ICD coded inpatient visit occurring before the estimated last menstrual period (LMP). Vasculitis was further categorized by vessel size: large, medium, small, and variable based on Chapel Hill Consensus Conference criteria. As a referent population we included those without vasculitis or other rheumatic disease, defined as no ICD coded outpatient or inpatient visits for vasculitis, systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, or juvenile idiopathic arthritis before LMP or during pregnancy. We described pregnancy outcomes in patients with vasculitis compared to the referent population. We also explored pregnancy characteristics and complications in patients with vasculitis stratified by parity (nulliparous vs multiparous).

Results: There were 665 pregnancies among 527 patients with vasculitis and 4,209,034 pregnancies among 2,932,379 patients from the referent population. Patients with vasculitis had a higher frequency of spontaneous abortion, elective termination, ectopic and molar pregnancy, and nearly two times as much preterm delivery compared to the referent population. Approximately 12% of pregnancies among patients with vasculitis were complicated by preeclampsia. Multiparous pregnancies compared to nulliparous had a slightly higher frequency of preterm delivery and were more often comorbid with gestational diabetes, pre-pregnancy hypertension, obesity, and hypothyroidism. Patients with small vessel vasculitis had higher frequencies of spontaneous abortion, preterm delivery, and comorbidities among vasculitis subtypes.

Conclusion: Pregnancies among patients with vasculitis had a higher frequency of spontaneous abortion and preterm delivery. Risk of maternal complications associated with vasculitis were observed to vary by vessel size and parity. These findings further the knowledge base and provide patients with up-to-date statistics on outcomes and complications.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-outcomes-among-patients-with-vasculitis-using-administrative-claims-data/