Fertility and pregnancy in vasculitis

Despite the rarity of vasculitides, fertility and pregnancy outcome in the setting of vasculitis have become a major topic of interest within the past decade. The potential impact of vasculitis therapies, particularly cyclophosphamide, has been examined to some extent, but data are limited on the po...

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Bibliographic Details
Published in:Best practice & research. Clinical rheumatology 2013-02, Vol.27 (1), p.79-94
Main Authors: Pagnoux, Christian, Mahendira, Dharini, Laskin, Carl A
Format: Article
Language:English
Subjects:
Anti-neutrophil cytoplasmic antibody (ANCA)
Autoimmune Diseases - prevention & control
Corticosteroids
Female
Fertility - physiology
Humans
Hypertension - prevention & control
Immunosuppressants
Immunosuppressive Agents - adverse effects
Immunosuppressive Agents - therapeutic use
Infertility
Male
Pregnancy
Pregnancy Complications, Cardiovascular
Pregnancy Outcome
Preterm birth
Renal Insufficiency - prevention & control
Rheumatology
Sterility
Vasculitis
Vasculitis - complications
Vasculitis - physiopathology
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Summary:Despite the rarity of vasculitides, fertility and pregnancy outcome in the setting of vasculitis have become a major topic of interest within the past decade. The potential impact of vasculitis therapies, particularly cyclophosphamide, has been examined to some extent, but data are limited on the possible impact of the disease itself on fertility. Ideally, pregnancy should be planned when the vasculitis is in remission. The outcome for mothers and newborns is usually good when vasculitis is known before the pregnancy and is in remission, but every pregnant woman must be monitored by a specialised health-care team consisting of obstetricians specialised in high-risk births and internists/rheumatologists with expertise in managing these rare conditions. Most maternal complications during pregnancy are indeed due to vasculitis damage: hypertension in Takayasu arteritis (TAK) or granulomatosis with polyangiitis (GPA)/microscopic polyangiitis (MPA) with renal insufficiency, asthma or cardiac damage in eosinophilic granulomatosis with polyangiitis (EGPA) and subglottic and/or bronchial stenosis(es) in GPA. Pregnancy loss can occur in about 10% of cases in GPA, up to 20% in EGPA, 20–30% in Behçet's disease and up to 25% in TAK, and several studies found high rates of preterm births, at least with some vasculitides. Vasculitis manifestations in newborns from mothers with known vasculitis are very rare and usually transient.
ISSN:1521-6942
1532-1770
DOI:10.1016/j.berh.2013.02.002