Henoch-Schonlein purpura in pregnancy

Pregnancy outcome in patients with a medical history of immunoglobulin A vasculitis: a case-control study

OBJECTIVE

Data on obstetric outcomes in patients with a history of immunoglobulin A vasculitis (IgA-V) are lacking. The aim of this study was to assess maternal, neonatal, and vasculitis outcomes during pregnancy.

METHOD

We conducted a French retrospective case-control study. Pregnancies of patients with a history of IgA-V (cases) were retrospectively studied and compared to pregnancies in women who developed IgA-V after their pregnancies and to pregnancies in healthy women (controls).

RESULTS

Twenty-six pregnancies in patients with a history of IgA-V were included and compared to 15 pregnancies in women who later developed IgA-V and 52 pregnancies in healthy women. Both gestational hypertension and pre-eclampsia were more frequent in the case group than in the other groups (23% vs 0% vs 0%, p < 0.01; 12% vs 7% vs 0%, p = 0.04). Hypertensive disorder of pregnancy occurred more frequently in patients with pre-existing kidney disease (78% vs 12%, p < 0.01). Caesarean section was more often performed in the case group than in the other groups (27% vs 0% vs 10%, p = 0.04). No foetal loss or maternal deaths occurred. There were no differences in delivery term or birth weight. No vasculitis flares were observed during pregnancy.

CONCLUSION

Women with a history of IgA-V appear to be at higher risk for gestational hypertension and pre-eclampsia, especially in cases with renal involvement; however, both mother and newborn outcomes appear to be favourable.

Glomerular diseases in pregnancy: pragmatic recommendations for clinical management

Our understanding of the various aspects of pregnancy in women with kidney diseases has significantly improved in the last decades. Nevertheless, little is known about specific kidney diseases. Glomerular diseases are not only a frequent cause of chronic kidney disease in young women, but combine many challenges in pregnancy: immunologic diseases, hypertension, proteinuria, and kidney tissue damage. An international working group undertook the review of available current literature and elicited expert opinions on glomerular diseases in pregnancy with the aim to provide pragmatic information for nephrologists according to the present state-of-the-art knowledge. This work also highlights areas of clinical uncertainty and emphasizes the need for further collaborative studies to improve maternal and fetal health.

Pregnancy outcomes in women with a history of immunoglobulin A vasculitis

OBJECTIVES

Case series suggest an increased risk of pregnancy complications in women with a history of IgA vasculitis (IgAV); however, no large quantitative studies have examined this possible association to date. We compared pregnancy rates and outcomes between female IgAV patients and controls and assessed flare risk of IgAV during pregnancy.

METHODS

Using state-wide hospital morbidity data we compared rates for live birth, preterm birth, abortive outcome and gestational complications between female IgAV patients (International Classification of Diseases-9-Clinical Modification 287.0; International Classification of Diseases-10-Australian Modification D69.0) (n = 121) and non-exposed age-matched controls (n = 284) in Western Australia. Results presented are means compared by Kruskal-Wallis test and proportions with odds ratios (ORs) (95% CI) compared by χ2 testing.

RESULTS

There were 247 pregnancies in IgAV patients during which no disease flares were recorded and 556 pregnancies in controls. IgAV patients were younger at first pregnancy (24.7 vs 27.0 years, P < 0.01) and had 43 unsuccessful pregnancies (17.4%) and 204 live births with 17 preterm deliveries (8.3%). Women with IgAV had increased odds of spontaneous abortion (OR 1.9, 95% CI 1.1, 3.1, P = 0.04), preterm delivery (OR 2.0, 95% CI 1.1, 3.9, P = 0.02) and gestational hypertension (OR 4.7, 95% CI 2.3, 9.8). While gravidity did not differ (mean pregnancy number 2.4 vs 2.3, P = 0.36), IgAV patients had over a two-fold greater number of obstetric visits than controls (5.1 vs 2.5, P < 0.01).

CONCLUSIONS

Hospitalization for IgAV has little impact on fertility and IgAV rarely flares during pregnancy. However, a history of IgAV associates with increased odds of spontaneous abortions, gestational hypertension and preterm delivery.

Pregnancy outcomes in women with primary systemic vasculitis: a retrospective study

BACKGROUND/AIMS

Pregnancies in women with systemic vasculitis constitute high-risk pregnancies, and outcomes vary based on the size of the affected blood vessels. Currently, there is limited data describing pregnancy outcomes in these women. The aim of this paper is to evaluate pregnancy outcomes in women with large, medium, or small vessel vasculitis to aid preconceptional counseling and inform antepartum and intrapartum care.

METHODS

We included all women with large-, medium-, or small-vessel vasculitis and documented pregnancies attending high-risk pregnancy clinics at Mount Sinai Hospital, Toronto, Canada between 2001 and 2016. Pregnancy characteristics and outcomes were reported as proportions. Maternal, fetal/neonatal, and obstetric outcomes, stratified by type of vasculitis, were the main outcomes measured.

RESULTS

We identified 60 pregnancies in 50 women with systemic vasculitis. These included large-vessel (n = 10), medium-vessel (n = 5), small-vessel [n = 30, of which 16 were AntiNeutrophil Cytoplasmic Autoantibody (ANCA)-associated and 14 were immune-complex mediated], central nervous system (n = 3), and retinal (n = 2). Although vasculitis flares occurred with large-vessel (3/12), small-vessel (13/36), and retinal (2/3) vasculitis, only one was severe and involved hemoptysis requiring blood transfusion in a woman with ANCA-associated vasculitis. Preeclampsia complicated two pregnancies each with large- (25%) and small- (6%) vessel vasculitis. Intrauterine growth restriction (IUGR) only occurred with small-vessel vasculitis (10, 29.4%). Although seven (26.4%) viable pregnancies resulted in preterm birth, the mean gestational age was over 35 weeks.

CONCLUSION

Although women with systemic vasculitis can have successful pregnancies, they are at increased risk for late preterm birth. In addition, those with small-vessel vasculitis are at increased risk for IUGR and vasculitis flares.

Henoch-Schonlein purpura in pregnancy: A case report

Henoch-Schonlein purpura is a relatively common pediatric vasculitis. Very few cases of Henoch-Schonlein purpura during pregnancy have been described. Henoch-Schonlein purpura is variable in its presentation, from completely benign to possibly catastrophic complications. This rarely encountered condition in adults can also be a recurrence of a previous childhood disease. We present a case of a pregnant 40-year-old woman with Henoch-Schonlein purpura, resulting in a viable birth with no fetal complications. Her presentation is discussed in detail and a general presentation of Henoch-Schonlein purpura is explored, with particular attention to its rare onset during pregnancy.

Henoch-Schönlein purpura in the third trimester of pregnancy

Henoch-Schönlein purpura (HSP) is an IgA-mediated small vessels’ vasculitis that affects the skin, intestines and kidneys. Pregnancy has been reported as an exacerbating factor. We present the case of a 24-year-old primigravida with HSP that occurred in the third trimester and lasted up to the end of the successful delivery. She had pruritic maculopapular exanthema on her legs. Biopsy of a cutaneous lesion was performed for histopathologic features and direct immunofluorescence (DIF) for the presence of perivascular IgA deposition. Histopathology of the cutaneous lesion confirmed leukocytoclastic vasculitis. A DIF examination of the skin lesion confirmed deposits of fibrinogen in the small blood vessel walls. Six weeks following delivery, the skin lesions almost completely disappeared. Control laboratory findings were normal. This case of HSP might have been primarily associated with a preceding respiratory infection but this should first be carefully investigated due to a possible severe immunological disease in the patient’s background requiring special attention since nephrotic symptoms may occur.

Pregnancy and vasculitis

Until recently, the prognosis associated with many forms of systemic vasculitis was quite grim. Advances in this field have allowed us to begin to focus on issues related to quality of life such as fertility, conception, and pregnancy among women with vasculitis. Because the systemic vasculitides are rare diagnoses, many important questions remain unanswered. Overall, it seems that women who have inactive vasculitis may not be subject to unusual complications during pregnancy, but our understanding of the interaction between pregnancy and specific forms of vasculitis continues to evolve.