Background Takayasu’s arteritis (TA) is a large vessel vasculitis of the young women in their reproductive age. It’s been previously reported as having conflicting results on the pregnancy outcome in TA.
Objectives Herein, we reported the pregnancy outcome and the effect of the pregnancy on the disease course in a well established TA cohort.
Methods TA patients diagnosed by ACR criteria and had the history of pregnancy were included into the study. Clinical and laboratory findings including serum ESR and CRP levels were evaluated both retrospectively and prospectively. Pregnancy and newborn outcome consists of the history of abortus, delivery mode, prematurity, intrauterin growth retardation, preeclampsia and eclampsia that were obtained from medical records. Data were noted into a predefined protocol. Disease activity and damage evaluated by Kerr criteria and VDI and concomittant immunosuppressives were recorded within the 3rd trimester and 6 months of pre and postpartum period in a subgroup prospectively followed-up. Pre-diagnosis (pre-d) and post-diagnosis (post-d) pregnancies were compared according to the maternal and fetal outcome.
Results Eighty-two pregnancies in 34 patients were assessed in TA cohort of 103 patients. Only 10% of all pregnancies were planned. Mean (median) age of 34 patients at pregnancy period were 24,5±6,6 (22). Subclavian (85%), carotis (44%) and pulmonary arteries (26%) were the most frequently involved vessels. Hypertension (47%), pulselessness (%34), mild pulmonary hypertension (18%) related to valvular disease (26%) were the prominent clinical features. Comparison of fetomaternal prognosis between the pre-d (63 in 24 TA) and post-d (19 in 15 TA) pregnancies demonstrated that hypertension (3% vs 16%), preeclampsia (0% vs 10%), prematurity (2% vs 10%) and Cesarean section (CS) (9% vs 37%) were significantly high in post-d pregnancies. Eight patients (of 4 newly diagnosed) prospectively followed-up during their pregnancies. Glucocorticoid (GC) (4 pts) and azathioprin (2 pts) were maintained after taking the patients’ consents. Four patients had flare during the 3rd trimester. Two of 4 patients had taken 10 mg/d GC and other 2 patients denied to be treated. The patient had renal artery involvement complicated with preeclampsia and the other experienced accelerated hypertension. Five TA patients underwent Ceaserean section mainly because of the probable risk of cerebral hypoperfusion during the delivery. One TA patient who was exposed to infliximab during the conception, has since been followed-up succesfully at the 3rd trimester under the low dose of GC. There were no obvious fetomaternal abnormality in TA cohort. No flare was observed during the 6th month of postpartum period. VDI scores did not increase in all patients.
Conclusions Majority of the pregnancies were found as successfull in a well established TA cohort. Higher rates of preeclampsia, prematurity and CS in post-d pregnancies were attributed to the exposure of GC treatment and physicians’ bias for delivery route. CS and prematurity were found as similar with our healthy population rates. Flares did not cause damage accrual in a short postpartum follow-up period. Flare has to be differentiated from the aberrant physiological changes and acute phase increase during the pregnancy. Close monitorization of arterial tension could be helpful for maintaining succesful pregnancy
Disclosure of Interest None Declared
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