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Bodakçi E, Cansu DÜ, Korkmaz C. Poor obstetric outcomes in women with takayasu arteritis: a retrospective cohort study. Rheumatol Int 2024; 44:1111-1117. [PMID: 38363321 PMCID: PMC11108923 DOI: 10.1007/s00296-024-05538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
The objective of this study was to assess the pregnancy outcomes in a cohort of patients who experienced pregnancies before and/or after being diagnosed with Takayasu's arteritis (TA). The present investigation encompassed a total of 88 pregnancies seen in a cohort of 35 patients who met the criteria outlined by the American College of Rheumatology in 1990 for the classification of Takayasu arteritis (TA). Pregnancies were classified into two categories. 1. Pregnancies that occurred before the diagnosis (pre-d or pre-TA) 2. Pregnancies that happened following a diagnosis (post-d or post-TA). Fifty-nine pregnancies (67.0%) occurred in 21 TA patients before the diagnosis with and a complication rate of 15.2%, and twenty-nine pregnancies (33.0%) occurred in 14 patients concomitant with or after TA diagnosis and complication rate 100%. Although the hypertension rate was higher in the pre-d group than in the post-d group, it was not significant (32.2% vs. 10.3%, p = 0.160). However, preeclampsia (20.6% vs. 0%, p = 0.001), low birth weight (27.5% vs. 1.6%, p = 0.001), and prematurity (24.1% vs. 1.6%, p = 0.035) were observed more frequently in the post-d group compared to the pre-d group. The frequency of abortions and in-utero deaths were similar in both groups (p > 0.05). Patients with hypertension had significantly higher rates of preeclampsia (p = 0.003), preterm birth (p = 0.036), low birth weight (p = 0.250), abortion (p = 0.018), in utero death (p = 0.128), and cesarean section (p = 0.005) than those without hypertension. Renal artery involvement was detected in 15 (42.8%) patients. All patients with renal artery involvement had hypertension, and they had significantly more pregnancy complications than the other group (p = 0.001). TA negatively affects pregnancy outcomes. A good control of arterial hypertension before conception and during pregnancy is critical to improve both maternal and fetal outcomes. In addition, detecting renal artery stenosis before pregnancy is important in reducing possible negative pregnancy outcomes.
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Affiliation(s)
- Erdal Bodakçi
- Division of Rheumatology, Department of Internal Medicine, Eskisehir State Hospıtal, Eskisehir, 26100, Turkey.
| | - Döndü Üsküdar Cansu
- Division of Rheumatology, Faculty of Medicine, Department of Internal Medicine, Eskişehir Osmangazi University, 26480, Eskişehir, Turkey
| | - Cengiz Korkmaz
- Division of Rheumatology, Faculty of Medicine, Department of Internal Medicine, Eskişehir Osmangazi University, 26480, Eskişehir, Turkey
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Beça S, Alba MA, Hernández-Rodríguez J, Espígol-Frigolé G, Prieto-González S, Cid MC, Baños N, Espinosa G. Maternal and fetal outcomes of pregnancy in women with primary systemic vasculitis: A single-center cohort study of 20 patients and 30 pregnancies. Semin Arthritis Rheum 2024; 66:152412. [PMID: 38387195 DOI: 10.1016/j.semarthrit.2024.152412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To analyze pregnancy outcomes of patients with primary systemic vasculitis followed in a third-level referral center. METHODS Retrospective cohort study of all pregnant women with systemic vasculitis followed between 2009 and 2022 at the High-Risk Pregnancy Clinic of the Department of Systemic Autoimmune Diseases of the Hospital Clínic, Barcelona. RESULTS Twenty women with primary vasculitis were identified, with a total of 30 pregnancies. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (n = 7) and Behçet disease (n = 4) were the most frequent types of vasculitis. All women had the diagnosis of vasculitis before pregnancy, with a median time between disease diagnosis and pregnancy of 5.8 years (range: 2 months-29 years). Most were in remission at conception (76.7 %). During pregnancy, a vasculitis flare occurred in 4 (13.3 %) patients (one each with Takayasu arteritis, eosinophilic granulomatosis with polyangiitis [EGPA], IgA vasculitis [IgAV], and Behçet disease [BD]). Four (16.7 %) of the successful pregnancies had post-partum relapses (one each with EGPA, granulomatosis with polyangiitis, IgAV, and BD). Eighty percent of pregnancies resulted in live babies. In four cases (13.3 %), medical termination of pregnancy was decided, considering the mother or baby health risk. There were two spontaneous miscarriages, and no stillbirths or neonatal deaths. Preeclampsia was the most frequent maternal complication (25 %). Newborns were preterm in 24 % and low birthweight in 20 % of cases. No maternal deaths occurred. CONCLUSIONS This cohort study shows that vasculitis relapses during pregnancy and post-partum, together with other pregnancy complications, occur in a considerable number of patients with systemic vasculitides, although a final good pregnancy outcome can be expected in most cases. These findings emphasize the convenience of managing these special situations in expert reference centers.
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Affiliation(s)
- Sara Beça
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Marco A Alba
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Georgina Espígol-Frigolé
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Sergio Prieto-González
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - María C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Núria Baños
- Department of Maternal-Fetal Medicine, BCNatal, Barcelona Centre for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain.
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Taghiyeva A, Kılıç L, Cagan M, Cagri Bolek E, Yardımcı GK, Ozyuncu O, Bilgen ŞA, Karadag O. Fertility, early menopause and pregnancy outcomes of patients with Takayasu's arteritis. Eur J Obstet Gynecol Reprod Biol 2023; 283:1-5. [PMID: 36746073 DOI: 10.1016/j.ejogrb.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 12/03/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The reproductive health of patients with Takayasu's arteritis (TA) is an important issue. Systemic inflammation and treatments used in TA may affect female reproductive organs, leading to infertility, maternal and fetal morbidity, and early menopause. This study aimed to evaluate fertility, early menopause and pregnancy outcomes of patients before and after TA diagnosis. In addition, pregnancy morbidities following TA diagnosis were analysed for each cluster. STUDY DESIGN Two hundred and two patients with TA (184 females) who met the 1990 American College of Rheumatology criteria were registered in the prospective database of Hacettepe University Vasculitis Research Centre by the end of February 2020. Demographic and clinical features, comorbidities, distribution of vascular involvement, obstetric histories and outcomes were evaluated retrospectively. Patients with TA were classified according to novel proposed disease clusters. Early menopause was defined as menopause before 45 years of age. RESULTS One hundred and twenty-one female patients with TA, for whom gynaecological records and marriage status could be obtained, were included in the study. Ninety-seven patients were married, of whom 12 (12.5 %) patients were infertile. In total, there were 238 pregnancies in 83 female patients with TA: 203 before TA diagnosis, 35 after TA diagnosis, and two patients were diagnosed during pregnancy. Compared with the pre-diagnosis group, maternal complications were significantly more common in the post-diagnosis group [23 (11.3 %) vs 9 (25.7 %); p = 0.048]. The most common maternal complication was gestational hypertension (12.1 %). Fetal complications were common in both groups (21.5 % pre-diagnosis vs 34.2 % post-diagnosis; p = 0.18), and included prematurity, intrauterine growth retardation and low birth weight. According to novel disease subsets, post-diagnosis patients were classified as C1 (n = 3, 15.7 %), C2 (n = 9, 47.3 %) or C3 (n = 6, 31.5 %). One patient could not be classified. There was no difference in obstetric outcomes between these subgroups. Early menopause was observed in 20 (16.5 %) of 121 patients, but some patients had not yet reached 45 years of age. CONCLUSION Infertility was higher in patients with TA in comparison with the general population in Turkey (12.5% vs 8.6%), and the early menopause rate was lower in patients with TA (16.7% vs 36.1%). Pregnancies following a diagnosis of TA had more maternal complications than pre-diagnosis pregnancies. Fetal complications were more common both pre- and post-diagnosis. Chronic inflammation before TA diagnosis may lead to increased infertility and fetal complications.
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Affiliation(s)
- Arzu Taghiyeva
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Levent Kılıç
- Hacettepe University Vasculitis Research Centre, Ankara, Turkey
| | - Murat Cagan
- Division of Perinatology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | | | - Ozgur Ozyuncu
- Division of Perinatology, Department of Obstetrics and Gynaecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Omer Karadag
- Hacettepe University Vasculitis Research Centre, Ankara, Turkey
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He S, Li Z, Zhang G, Song Y, Li J, Yang Y, Zhao J, Wang Y, Tian X, Zeng X. Pregnancy Outcomes in Takayasu Arteritis Patients. Semin Arthritis Rheum 2022; 55:152016. [DOI: 10.1016/j.semarthrit.2022.152016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/05/2022] [Accepted: 04/25/2022] [Indexed: 11/15/2022]
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Gönenli MG, Kaymaz Tahra S, Kara M, Keser G, Yazıcı A, Erden A, Omma A, Gerçik Ö, Akar S, Aksu K, Kenar G, Kocaer SB, Önen F, Ersözlü D, Alibaz-Öner F, Bayramlar OF, Direskeneli H, Alpay-Kanıtez N. Pregnancy in Takayasu's arteritis has a high risk of hypertension-related fetomaternal complications: A retrospective study of a Turkish cohort. Int J Rheum Dis 2021; 25:140-146. [PMID: 34791826 DOI: 10.1111/1756-185x.14247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to examine fetomaternal outcomes in pregnant women in a large Turkish Takayasu arteritis (TAK) cohort and to evaluate the effects of pregnancy on the disease in those patients. METHODS This is a cohort study involving 296 pregnancies of 112 TAK patients from 8 tertiary rheumatology centers in Turkey. Pregnancies were divided into 2 groups as pre-d (before disease onset) and post-d (after disease onset). In addition, post-d pregnancies were further divided into 2 subgroups according to fetomaternal complications (FMC) development status. Finally, patients were grouped into those with and without a history of pregnancy after disease onset. RESULTS In post-d pregnancies, rates of worsening hypertension, new-onset hypertension, and preeclampsia were higher than in pre-d pregnancies (0.9% vs 16%, P < .001, 0.5% vs 5.3%, P = .012, and 0% vs 4%, P = .013, respectively). Patients with FMC were more likely to have renal artery involvement (65% vs 21%, P = .003). The patients who had post-d were younger, had longer disease duration, and had more relapses number than other patients (P < .001, P = .028, P = .016, respectively). Vasculitis Damage Index (VDI) results were similar in patients with or without post-d pregnancies. CONCLUSION Pregnancies after disease onset were found to be associated with HT and preeclampsia/eclampsia. HT-related FMCs are increased in TAK, and patients with renal artery involvement are at higher risk. The number of relapses increases in patients who become pregnant after disease onset, but pregnancy was not an independent risk factor for relapse. Pregnancy after the onset of disease had no negative effect on VDI.
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Affiliation(s)
| | | | - Mete Kara
- Ege University School of Medicine, Izmir, Turkey
| | - Gökhan Keser
- Ege University School of Medicine, Izmir, Turkey
| | - Ayten Yazıcı
- Kocaeli University School of Medicine, Kocaeli, Turkey
| | | | - Ahmet Omma
- Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Önay Gerçik
- Katip Celebi University School of Medicine, Izmir, Turkey
| | - Servet Akar
- Katip Celebi University School of Medicine, Izmir, Turkey
| | - Kenan Aksu
- Ege University School of Medicine, Izmir, Turkey
| | - Gökçe Kenar
- Dokuz Eylul University School of Medicine, Izmir, Turkey
| | | | - Fatoş Önen
- Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Duygu Ersözlü
- Ministry of Health Adana City Training and Research Hospital, Adana, Turkey
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Singhal S, Meena J, Kumar S, Roy KK, Singh N, Shekhar B, Yadav A, Kumari S, Jayraj AS. Maternal and Perinatal Outcomes of Pregnancy in Women With Autoimmune Disorder. Cureus 2021; 13:e16024. [PMID: 34336512 PMCID: PMC8320712 DOI: 10.7759/cureus.16024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Pregnancy with an autoimmune disorder is faced with several risks for mother and fetus. The aim of the present study is to analyze the course and outcome of pregnancy in women with autoimmune disorders (AIDs). Methods A retrospective cohort study was conducted at a tertiary care teaching hospital. The hospital records of 153 pregnancies with autoimmune disorders and 1095 low-risk pregnant women who served as controls were reviewed. An adverse perinatal outcome was defined as the presence of any obstetric complications, including preeclampsia, eclampsia, abruption, antepartum hemorrhage (APH), prematurity, fetal growth restriction (FGR), intrauterine death (IUD), intrapartum event, mode of delivery, birth weight, neonatal intensive care unit (NICU) stay, or disease-specific neonatal complications. For all statistical tests with two-tailed probability, p<0.05 was considered statistically significant. Results A high incidence of adverse perinatal outcomes was observed in all women with AIDs when compared with age-matched controls. The highest incidence of adverse perinatal outcomes was observed in women with Takayasu’s arteritis. The incidence of abortions was more in women with antiphospholipid antibody syndrome (APS) and Grave’s disease (22.2% and 33.3%, respectively). The incidence of prematurity, fetal growth restriction (FGR), and low birth weight were highest in women with systemic lupus erythematosus (SLE). Pregnancy with myasthenia gravis and rheumatoid arthritis did not have any significant adverse impact on pregnancy outcomes. Conclusion We found a strong association between autoimmune disorders and obstetric complications. The multidisciplinary team approach and pre-pregnancy optimization of the disease improve maternal and fetal outcomes.
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Affiliation(s)
- Seema Singhal
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Jyoti Meena
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Sunesh Kumar
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - K K Roy
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Neeta Singh
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Bhawani Shekhar
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Anshu Yadav
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Sarita Kumari
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Aarthi S Jayraj
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
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Padiyar S, Manikuppam P, Kabeerdoss J, Rathore S, Danda D. Update on pregnancy in Takayasu arteritis-A narrative review. Int J Rheum Dis 2021; 24:758-765. [PMID: 33870620 DOI: 10.1111/1756-185x.14109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
Takayasu arteritis (TA) is a chronic, idiopathic large-vessel vasculitis that affects women of reproductive age, and has significant maternal and fetal implications. Although there are contrasting data on the effect of TA on fertility, most studies have shown that fertility outcomes remain unaffected. The disease activity of TA usually either remains stable or decreases during pregnancy. The important fetomaternal complications are maternal hypertension, pre-eclampsia, prematurity, and intrauterine growth restriction. To reduce maternal and fetal morbidity, controlling the disease before conception is important. This review article discusses the various implications, challenges, and medical and endovascular management of TA during pregnancy.
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Affiliation(s)
- Shivraj Padiyar
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Prathyusha Manikuppam
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Jayakanthan Kabeerdoss
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Swati Rathore
- Department of Obstetrics and Gynecology, Christian Medical College, Vellore, India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
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Singh S, Pati A, Mohakud S, Behera DR. Takayasu’s Arteritis in Pregnancy: Challenges During the Ongoing Coronavirus Disease 2019 Pandemic for Optimal Maternal and Neonatal Outcomes. Cureus 2020; 12:e12386. [PMID: 33532151 PMCID: PMC7845754 DOI: 10.7759/cureus.12386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Koster MJ, Warrington KJ, Matteson EL. Morbidity and Mortality of Large-Vessel Vasculitides. Curr Rheumatol Rep 2020; 22:86. [DOI: 10.1007/s11926-020-00963-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Purpose of Review In recent years, improvements in the recognition of primary vasculitides and increased treatment options have led to greater survival rates and a better quality of life for patients. Therefore, pregnancy in women with vasculitis has become a more frequent consideration or event. Literature on pregnancy outcomes in this population has grown and allowed us, in this article, to review the effects of pregnancy on disease activity, as well as maternal and fetal outcomes for each type of vasculitides. Recent Findings Successful pregnancies in patients with vasculitides are possible, especially when conception is planned, and the disease is in remission. The risk of vasculitis flare is highly dependent on the type of vasculitis, but overall limited. The most frequent complication associated with large-vessel vasculitis (mainly Takayasu arteritis) is hypertension and preeclampsia. Preterm deliveries and intrauterine growth restriction occur more frequently with small- and medium-vessel vasculitis. Summary Pregnancies in patients with vasculitis should be considered high risk and followed by a multidisciplinary team with expertise in the field. Flares should be managed as in the non-pregnant population, while avoiding medications with unknown safety in pregnancy or known teratogens. Although commonly prescribed for the prevention of preeclampsia, there is limited evidence supporting the use of low-dose aspirin for pregnant women with vasculitis. Prospective registries or studies are needed, to better assess the value of aspirin, the place and long-term impact of new biologics and, to identify predictors of pregnancy outcomes other than disease status at conception.
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Affiliation(s)
- Carolyn Ross
- Vasculitis Clinic, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Rohan D'Souza
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Christian Pagnoux
- Vasculitis Clinic, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
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David LS, Beck MM, Kumar M, Rajan SJ, Danda D, Vijayaselvi R. Obstetric and perinatal outcomes in pregnant women with Takayasu’s arteritis: single centre experience over five years. J Turk Ger Gynecol Assoc 2020; 21:15-23. [PMID: 31564080 PMCID: PMC7075400 DOI: 10.4274/jtgga.galenos.2019.2019.0115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/22/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To study obstetric and perinatal outcomes among pregnant women with Takayasu arteritis (TA), attending our hospital for pregnancy and childbirth between January 2011 to December 2016. Material and Methods Retrospective study was carried out by abstracting clinical charts on all pregnant women with TA who underwent antenatal care and/or delivery in our hospital during this period. American College of Rheumatology criteria was used for diagnosis of TA. Sixteen women with TA were included in the study. Maternal demographic data, stage of disease, complications related to disease, details of treatment taken prior to pregnancy, pregnancy outcomes, and neonatal outcomes were studied. Results Forty-four percentage (7/16) belonged to type 5 angiographic type, however the same proportion (7/16) had undergone surgical corrections prior to pregnancy and the majority (15/16) were on medical management. Only three women (19%) were diagnosed during pregnancy. Most did not have active disease measured by Kerr’s criteria (n=12; 75%), and Indıan Takayasu clinical activity scores A. Chronic hypertension was the commonest antenatal complication (56.2%), nearly one-third had growth restricted babies and 25% had preterm labour. There were no cardiovascular events, no maternal deaths, nor fetal or neonatal deaths. Two-thirds of our women were delivered by caesarean section. Conclusion Preconceptional counselling is of paramount importance in women with TA. Good maternal and fetal outcomes are observed with close antenatal surveillance and multidisciplinary care. Pregnancy should be planned during disease remission, with good antenatal care, close monitoring of clinical symptoms, early diagnosis and treatment of complications.
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Affiliation(s)
- Liji Sarah David
- Clinic of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
| | - Manisha Madhai Beck
- Clinic of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
| | - Manish Kumar
- Clinic of Neonatology, Christian Medical College and Hospital, Vellore, India
| | - Sudha Jasmine Rajan
- Clinic of Obstetric Medicine, Christian Medical College and Hospital, Vellore, India
| | - Debashish Danda
- Clinic of Rheumatology, Christian Medical College and Hospital, Vellore, India
| | - Reeta Vijayaselvi
- Clinic of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
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Bharuthram N, Tikly M. Pregnancy and Takayasu arteritis: case-based review. Rheumatol Int 2019; 40:799-809. [PMID: 31858208 DOI: 10.1007/s00296-019-04499-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022]
Abstract
Takayasu arteritis (TA) is a rare large vessel vasculitis that particularly affects women of child-bearing age. Management of pregnant patients with TA is often challenging due to the cardiovascular and cerebrovascular complications of the disease. We report two new cases of pregnancy in patients with TA and review all published cases from sub-Saharan Africa. Analysis of 16 pregnancies in 15 patients (including our two cases) showed that seven patients had radiographic Type V TA disease, namely involvement of the entire length of the aorta. Four patients were newly diagnosed with TA during pregnancy and two pregnancies were unbooked at time of first presentation. Seven pregnancies were complicated by disease flares (n = 4) and/or hypertension (n = 6). Four pregnancies resulted in preterm delivery and six required caesarean sections. There was one documented case of pre-eclampsia resulting in the only maternal death. Intrauterine growth restriction was documented in two of six pregnancies in which foetal ultrasonography was performed. There were four low birth weight infants and one fresh stillbirth (associated with the maternal death). In the handful of case reports of pregnancy in TA from sub-Saharan Africa, both maternal and foetal outcomes were generally good and similar to international findings. In a substantial proportion of patients, the diagnosis of TA was made in pregnancy, reflecting challenges of access to appropriate health care in resource constrained sub-Saharan Africa.
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Affiliation(s)
- Nirvana Bharuthram
- Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Mohammed Tikly
- Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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