Background/Purpose: Systemic Vasculitis (SV) are rare diseases that may affect females during childbearing age. Quite a few data are available in literature, and mostly from case reports. Aim of our study is to evaluate the maternal/neonatal outcome, the activity of maternal disease before, during and after pregnancy in patients with diagnosis of SV followed in five Italian Institutions.
Methods: Our study is a retrospective analysis of 43 pregnancies (prospectively followed by a multispecialistic team, with a least 1 documented visit each trimester) in 33 patients with diagnosis of SV, according to Chapel Hill Consensus Conference and/or ACR Criteria for SV. We collected: Takayasu Arteritis (TA) (6pregnancies in 4 patients), Churg-Strauss Syndrome (CS) (6 in 6 pt), Polyarteritis Nodosa (PA) (3 in 2 pt), Behcet’s Disease (BD) (20 in 16 pt), Wegener Granulomatosis (WG) (3 in 3 pt), Henoch-Schönlein (HS) (2 in 1 pt) and ANCA associated-neuropathy (3 in 1 pt). Data regarding the duration of disease, serological and clinical features, pregnancy outcome, neonatal and maternal complications and therapy during pregnancy were collected from clinical charts.
Results: The mean age of the patients at the onset of the disease was 24.7yrs (with standard deviation (SD) of 6.9 yrs) and at the diagnosis was 26yrs (SD6.1yrs); our patients were Caucasians (28), afro-americans (2), Asians (2) and African (1). The mean duration of SV before pregnancy was 6,5 yrs (SD 5yrs). 5 patients were ANCA positive. 11 patients had been treated with cytotoxic or embriotoxic drugs but none of the pregnancies were exposed to such drugs. 1 out the 3 patients previously treated with cyclofosphamide had primary ovarian failure (POF). Five pregnancies were obtained by in vitro fertilization (all because of female infertility), one by oocyte donation in the patient with POF. During the 43 pregnancies, 6 flares of SV occurred during the first trimester (13.9%), 7 (20%) occurred in the 35 evaluable in the second trimester and 3 in 33 (9%) whose data are available in the third trimester. The onset of BD at 10°week of gestation was reported in one patient. Pregnancy-related complications occurred in 14 pregnancies, among which 4 cases of gestational diabetes. The mean week of delivery was 37.7 (SD 3 weeks) with 5 preterm delivery (before the 34°week). The pregnancy outcome was 33 live births (2 twins pregnancy), 8 miscarriages (1in a twin pregnancy), 1 fetal death. 2 pregnancies are still ongoing. 6 newborns had neonatal complications. Data about the postpartum period were available for 34 pregnancies:11 flares (32.3%) occurred.
Conclusion: Our data show that a strict multidisciplinary monitoring does not prevent maternal/neonatal complications in patients with Systemic Vasculitis. In addition puerperium should be regarded as a risk period for vasculitis flares, similarly to other systemic autoimmune diseases.
Disclosure:
M. Fredi,
None;
M. G. Lazzaroni,
None;
C. Tani,
None;
V. Ramoni,
None;
M. Gerosa,
None;
F. Inverardi,
None;
L. Andreoli,
None;
L. Trespidi,
None;
M. Motta,
None;
A. Lojacono,
None;
R. Sinico,
None;
A. Brucato,
None;
R. Caporali,
None;
P. L. Meroni,
None;
C. Montecucco,
None;
M. Mosca,
None;
A. Tincani,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-vasculitis-and-pregnancy-a-multicenter-study-on-maternal-and-neonatal-outcome-of-43-prospectively-followed-pregnancies/