New research presented this week in ACR Convergence, the annual meeting of the American College of Rheumatology, shows that pregnant women with Takayasu’s arteritis, a type of large blood vessel inflammation, appear to have a significantly higher prevalence of serious adverse maternal and fetal outcomes. During pregnancy and childbirth, these patients should be closely monitored by a multidisciplinary medical team (Abstract No. 1728).
Takayasu’s arteritis is more common in women, and it involves inflammation of the walls of the body’s largest artery, the aorta and its major branches. The disease results from an attack by the body’s immune system, causing inflammation in the walls of the arteries. Inflammation causes the arteries to narrow, reducing blood flow to many parts of the body.
About 90% of patients diagnosed with Takayasu’s arteritis are under 30 years of age. Previous research suggests that the disease is associated with adverse pregnancy outcomes, including pre-eclampsia, but the specific prevalence of this complication has not been clear. The researchers conducted a systematic review and meta-analysis of multiple studies to find out more.
The aim of this study was to investigate the prevalence of maternal and fetal complications during pregnancy for patients with Takayasu’s arteritis. As a result, we have not evaluated any association between prednisolone use and adverse maternal or fetal outcomes.”
Ayn Gorman, MD, an intern in rheumatology at Trinity College Dublin, Ireland and co-author of the study
The researchers collected data from 23 studies reporting pregnancy outcomes in Takayasu’s arteritis patients published through March 2021. They pulled demographic information on patients, maternal and fetal outcomes, prednisolone glucocorticoid use and data on patients’ disease activity. Two authors independently selected the studies used, extracted data and assessed them for any risk of bias.
The results highlight serious concerns for Takayasu patients. They had a miscarriage rate of 11% and an intrauterine mortality rate of 1%. Premature delivery occurred in 15% of these patients, new gestational hypertension developed in 12% of cases, and intrauterine growth restriction occurred in 16% of these pregnancies. In addition, 28% of pregnant patients who had Takayasu’s delivery required a caesarean section, and 16% of the live-born babies were of low birth weight. The study also found that 11% of pregnant women with Takayasu disease had vasculitis. Across the time periods of these studies, from 1982 to 2020, the prevalence of preterm birth, preeclampsia, and caesarean section increased.
“The results of this study highlight the importance of a multidisciplinary team approach when a Takayasu arteritis patient is pregnant, with input required by many healthcare professionals. These patients appear to have a high prevalence of serious maternal and fetal complications and should be carefully monitored for research About flares and complications of pregnancy and childbirth.
American College of Rheumatology