This study analyzes pregnancy outcomes in women with large, medium or small vessel vasculitis with the intent of aiding pre-conceptional counselling and informing antepartum and intrapartum care of these women.METHODS:
We conducted a retrospective study of women with large-, medium- or small-vessel vasculitis and documented pregnancies between 2001 and 2016, identified from the Special Pregnancy Program Database at Mount Sinai Hospital, Toronto. We obtained information from hospital records and analyzed maternal, fetal/neonatal and obstetric outcomes between the different vasculitides.RESULTS:
We identified 60 pregnancies in 50 women including 10 with large-vessel vasculitis (Takayasu’s arteritis), five with medium-sized vessel vasculitis, 30 with small-vessel vasculitis (16 ANCA-associated vasculitis, 14 with other such as IgA vasculitis), three with central nervous system vasculitis and two with retinal vasculitis. Vasculitis flares occurred in women with large-vessel (3/12), small-vessel (13/36) and retinal (2/3) vasculitis. Pregnancy complication rates were low, with one case each of first-trimester miscarriage, congenital anomaly, stillbirth and gestational diabetes. Although seven (26.4%) viable pregnancies resulted in preterm birth, the mean gestational age, regardless of the type of vasculitis, was over 35 weeks of gestation. Fetal growth restriction only occurred with small-vessel vasculitis (10 newborns, 28.6%). Of the 44 deliveries, 22 (50%) were spontaneous vaginal deliveries. All caesarean (18, 40.9%) and assisted vaginal (7, 15.9%) deliveries were for obstetric indications.CONCLUSION:
With multidisciplinary management, women with vasculitis can anticipate excellent maternal and fetal outcomes, although they are at increased risk for late preterm birth.