2015 ACR/ARHP Annual Meeting Abstract Supplement

Abstract

Background/Purpose: Takayasu arteritis (TA) is a large-vessel vasculitis that affects young women of childbearing age. We aimed to analyze the outcome of pregnancies in TA patients and to identify the factors associated with maternal and neonatal prognosis. Methods: We conducted a French nationwide retrospective study of pregnancies occurring in patients with a TA diagnosis. Results: Forty-one pregnancies occurred in 31 TA women between 1999 and 2015. Steroids were used in 25 pregnancies (61%), azathioprine in 9 (22%) and anti-TNF- agonist in 1 (3%). Nineteen pregnancies (46%) were complicated by at least one obstetrical adverse event: 14 gravida arterial hypertension (34%) with 3 pre-eclampsia (7%), 1 HELLP syndrome (2%), 6 intrauterine growth restriction (15%), and 2 postpartum hemorrhage (5%). Delivery was vaginal in 22 (54%) and by cesarean section in 19 pregnancies (46%).There were 40 live births (98%) with a median term of 38 [27-42] weeks of gestation with 8 premature birth (20%). The median birth weight was 2985 [1050-4310] grams with 7 neonates <2500 gr (17%). Four children required intensive care units (10%) and one died at 2 days of life. Maternal chronic arterial hypertension increased the risk of gravida arterial hypertension (p=0.01), of pre-eclampsia (p=0.04) and of cesarean delivery (p=0.01). The presence of renal artery stenosis before pregnancy increased the risk of fetal growth restriction (p=0.04). The presence of renal artery stenosis before pregnancy as well as the presence of infra-diaphragmatic vasculitis both increased the risk of low birth weight (p=0.03 and p=0.023 respectively). TA disease activity was observed in 8 pregnancies (20%), including 2 flares in previously inactive patients. The risk of flare or of TA activity was higher if TA had been active in the 6 months before pregnancy: 6 active disease in 10 pregnancies (60%) if TA had been active before pregnancy versus 2 in 31 (6%) if TA had been inactive (p=0.0011). Conclusion: We observed a high rate of obstetrical complications in this large series of pregnancies occurring in patients diagnosed with TA. The presence of chronic hypertension, infra-diaphragmatic vasculitis, renal artery stenosis or active disease before pregnancy were associated with poor pregnancy outcome. TA activity did not seem to be strongly influenced by pregnancy. (Table Presented).