Pregnancy and Takayasu's arteritis

doi:10.1016/0002-9343(83)90439-4

The American Journal of Medicine

Volume 75, Issue 4, October 1983, Pages 597-601

https://doi.org/10.1016/0002-9343(83)90439-4 Get rights and content

Abstract

Thirteen patients with Takayasu's arteritis had 30 pregnancies between 1970 and 1982. The 11 pregnancies occurring before the disease became clinically evident were uneventful. Eleven patients had 19 pregnancies after manifestation of the disease. Four ended in abortion, four in cesarean section, and 11 in uneventful vaginal delivery at term. There was no major obstetric problem apart from hypertension, and there was no maternal death directly related to the pregnancy per se. All 15 babies were born without asphyxia and congenital abnormality. The nine with some evidence of intrauterine growth retardation could be predicted by a prognostic score taking into account the timing of therapy, the severity of the hypertension, and the extent of arterial involvement.

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Cited by (83)

Maternal and fetal outcomes of pregnancy in women with primary systemic vasculitis: A single-center cohort study of 20 patients and 30 pregnancies
2024, Seminars in Arthritis and Rheumatism
To analyze pregnancy outcomes of patients with primary systemic vasculitis followed in a third-level referral center.
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.
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.
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.
Fertility, early menopause and pregnancy outcomes of patients with Takayasu's arteritis
2023, European Journal of Obstetrics and Gynecology and Reproductive Biology
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.
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.
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.
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.
Pregnancy issues in Takayasu arteritis
2020, Seminars in Arthritis and Rheumatism
Citation Excerpt :
Nevertheless, gestational hypertension is present in about 1:15 pregnancies and can occur independently of TAK disease. Rare fatal maternal complications have been reported such as aortic aneurysm and cerebral haemorrhage [4,13]. Manifestations of TAK disease described during pregnancy are various, such as renal insufficiency, retinopathy, aortic dissection, cerebrovascular accidents and cardiac insufficiency [10,16–18].
Takayasu arteritis (TAK) is a chronic inflammatory vasculitis of unknown origin affecting large vessels, predominantly the aorta and its main branches. TAK usually affects young women and the management of pregnancy during this vasculitis may be a challenging situation. After a review of the literature, we analysed the data of 505 pregnancies in 373 TAK patients. We discuss main results to clarify if the pregnancy outcome is affected by TAK, especially during disease clinical onset or disease activity. We also discuss the potential impact of pregnancy on TAK prognosis. Disease activity of TAK appears independently associated with a poor pregnancy outcome. More than 5% of pregnant women with TAK develop a life-threatening maternal cardiovascular complication. A good control of TAK disease activity and arterial hypertension before conception and during pregnancy is critical to improve both maternal and foetal outcomes. Pregnancies in the setting of TAK should be considered high-risk, requiring a close collaboration between specialists involved in the care of TAK and obstetricians.
Maternal and fetal outcomes in pregnant women with Takayasu aortoarteritis: Does optimally timed intervention in women with renal artery involvement improve pregnancy outcome?
2015, Taiwanese Journal of Obstetrics and Gynecology
Takayasu aortoarteritis (TA) is common in the Southeast Asian and Indian subcontinent regions with a female-to-male ratio of 8:1. Age at diagnosis is < 30 years in 90% of the cases. Because the disease is common in women of child-bearing age, management of pregnancy in these patients becomes an important issue. The purpose of this study is to evaluate the maternal and fetal outcomes in pregnancies with TA and also to evaluate whether early intervention for renal artery involvement is associated with improved outcomes.
We collected data of 12 patients with 18 pregnancies prospectively from 2006 to 2012. The patients were divided into three groups and their outcomes were noted: (1) without renal artery involvement; (2) with renal artery involvement without intervention; and (3) with renal artery involvement for which intervention has been done.
Body mass index of patients was between 18.5 kg/m² and 23.2 kg/m². Renal artery involvement and hypertension were seen in four patients. One patient had percutaneous transluminal balloon angioplasty and another had renal artery stenting. In patients without renal artery involvement, gestational hypertension was seen in 50%, pre-eclampsia in 10%, abortion in 10%, and intrauterine growth restriction (IUGR) in 40% of pregnancies. In patients with renal artery involvement without intervention, gestational hypertension was seen in 90%, pre-eclampsia in 20%, abortion in 60%, preterm in 20%, IUGR in 20%, fetal demise in 20%, and neonatal death in 20% of pregnancies. In patients with renal artery involvement for which intervention has been carried out, gestational hypertension was seen in 66%, and abortion and IUGR were seen in 33% of pregnancies.
Patients with renovascular involvement without intervention are at high risk of having maternal and fetal complications. Early intervention prior to conception in these women is recommended to prevent pregnancy complications.
Takayasu arteritis in pregnancy
2015, Medical Journal Armed Forces India
Citation Excerpt :
Pregnancy does not significantly affect the inflammatory activity of the disease. Wong et al studied 19 pregnancies in 11 patients and did not find any evidence of acute inflammatory exacerbation.7 Although the majority of women with TA do well in pregnancy and labor,4 those with secondary hypertension and cardiac involvement may be negatively impacted.
Anaesthetic management in a parturient with Takayasu arteritis
2012, Egyptian Journal of Anaesthesia
We report the anaesthetic management of a parturient suffering from Takayasu's arteritis scheduled for elective caesarean section. A full term 29-year-old female weighing 50 kg, height 152 cm, gravida3, para 1 with previous lower segment caesarean section (LSCS) was scheduled for elective LSCS. Patient had suffered a right sided frontoparietal infarct 14 years back for which she underwent treatment in the form of medication from some higher centre She was advised tablet aspirin 75 mg and prednisolone 40 mg once a day. Digital subtraction angiography showed complete occlusion of origin of both subclavian and carotids and reformation of collaterals. Echocardiography revealed mild concentric left ventricular hypertrophy, trivial AR and normal left ventricular systolic function. Caesarean section was planned under regional anaesthesia with monitoring gadgets placed on lower limb. Subarachnoid block (SAB) was administered with 7.5 mg hyperbaric bupivacaine along with 25 μg fentanyl at lumbar 4–5 interspace, using a 25-G Quincke Babcock needle. Intra-operative period was uneventful with minimal fall in blood pressure which was managed accordingly. Parturient was stable in the postoperative period and was moved to a ward after being monitored for 24 h in ICU.

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^☆: This work was presented as free communication at the 10th World Congress of Gynecology and Obstetrics, San Francisco, October 1982.

¹: From the Department of Obstetrics and Gynaecology and the Department of Medicine, University of Hong Kong, Hong Kong.

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Clinical studyPregnancy and Takayasu's arteritis☆

Abstract

Am Heart J

Am J Cardiol

A case with unusual changes of the central vessels in the retina

Acta Soc Ophthalmol Jpn

Pulseless disease

J Neuropathol Clin Neurol

Further observations on Takayasu's syndrome

Acta Med Scand

Clinical study
Pregnancy and Takayasu's arteritis☆