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OP0230 Systemic Vasculitis and Pregnancy: A Multicenter Study on Maternal and Neonatal Outcome of 66 Prospectively Followed Pregnancies
  1. M.G. Lazzaroni1,
  2. M. Fredi1,
  3. L. Andreoli1,
  4. A. Brucato2,
  5. R. Caporali3,
  6. P. Caramaschi4,
  7. A. Doria5,
  8. M. Gerosa6,
  9. L. Guillevin7,
  10. F. Inverardi3,
  11. A. Lojacono8,
  12. P.L. Meroni6,
  13. C. Montecucco3,
  14. M. Mosca9,
  15. M. Motta10,
  16. V. Ramoni3,
  17. P. Sfriso5,
  18. R.A. Sinico11,
  19. F. Strigini12,
  20. C. Tani9,
  21. A. Tincani1
  1. 1Rheumatology and Clinical Immunology, Spedali Civili and University of Brescia, Brescia
  2. 2Internal Medicine, Ospedali Riuniti, Bergamo
  3. 3Division of Rheumatology, Ospedale San Matteo and University of Pavia, Pavia
  4. 4Rheumatology and Internal Medicine, Univerisity of Verona, Verona
  5. 5Division of Rheumatology, Univerisity of Padova, Padova
  6. 6Rheumatology and Department of Internal Medicine, University of Milano and Istituto Ortopedico Gaetano Pini, Milano, Italy
  7. 7University Paris Descartes and National Referral Center for Necrotizing Vasculitides and Systemic Sclerosis, Hôpital Cochin, Paris, France
  8. 8Obstetrics and Gynecology, Spedali Civili and University of Brescia, Brescia
  9. 9Rheumatology Unit, University of Pisa, Pisa
  10. 10Neonatal Intensive Care Unit, Spedali Civili and University of Brescia, Brescia
  11. 11Clinical Immunology Unit, Department of Medicine, Ospedale San Carlo Borromeo, Milano
  12. 12Obstetrics and Gynecology, University of Pisa, Pisa, Italy

Abstract

Background Systemic Vasculitis (SV) are rare diseases and unlike other rheumatic diseases they do not preferentially affect women during reproductive age. A few data are available in literature, mostly from case reports with retrospective design [1,2].

Objectives Aim of our study is to prospectively evaluate maternal/neonatal outcome and disease course before, during and after pregnancy in patients with SV.

Methods 66 pregnancies in 44 women with diagnosis of SV (according to CHCC and or ACR criteria) were prospectively followed by a multispecialistic team composed by Rheumatologists, Gynecologists and Neonatologists in one of the 8 Institutions involved in a period comprised between years 1995 and 2013. Data were retrospectively collected from clinical charts using a common database. Data about a control population of 3939 healthy women in one center during one year (General Obstetric Population, GOP) were considered to compare the rate of pregnancy-related complications.

Results Outcome of pregnancy was 55 live births (85,9%), 8 miscarriages before 10° week (12,5%) and 1 fetal death after 10° week (1,5%); 2 pregnancies are still ongoing.

Data about pregnancy-related complications were compared to GOP: in SV patients preterm deliveries (20,0% vs 11,9%), severe (<34°weeks) preterm deliveries (10,1% vs 5,0%) and cesarean section (47,3% vs 31,0%) were significantly more frequent than in GOP.

Disease-related complications occurred in 24 pregnancies during the three trimesters (36,4%), with 8 severe events (12,1%) including 3 cases of transient ischemic attack.

Data about the postpartum period were available for 51 pregnancies: 11 flares (21,6%) occurred, with 1 severe event (1,9%).

Conclusions SV patients can have successful pregnancies, but with increased risk of preterm delivery. Pregnancy-related modifications (immunological, cardiovascular and thrombophilic) can negatively affect the course of disease, with severe complications. A tight control by a multispecialistic team should be a standard in pregnancies of women with SV.

References

  1. Gatto M et al. Pregnancy and vasculitis: a systematic review of the literature. Autoimmunity reviews 2012;11(6):A447-A459

  2. Pagnoux C, Mahendira D, and Laskin CA. Fertility and pregnancy in vasculitis. Best Practice & Research Clinical Rheumatology 2013;27(1):79-94

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.2312

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