AB0750 PREGNANCY DURING TAKAYASU VASCULITIS: ABOUT 24 PREGNANCIES

Abstract

Background: TAKAYASU vasculitis is a vasculitis of the large trunks mainly affecting women of childbearing age. Pregnancy during TAKAYASU disease may be associated with maternal and/or materno-fetal complications as well as a flare-up of this vasculitis. Adequate management of TAKAYASU disease as well as regular monitoring of pregnancy is necessary. in order to avoid these complications which can affect the maternal-fetal prognosis. Methods: We conducted a descriptive, analytical and observational retrospective study, spanning 36 years (1984-2020) at the internal medicine department of the UHC IBN SINA.102 patients are being followed up for Takayasu disease. We have listed the pregnancies carried out in patients during their follow-up for TAKAYASU disease. Results: During their follow-up for TAKAYASU's disease;10 patients carried out 24 pregnancies. Their mean age was estimated at 31.78 ±12.2 years (16-51 years).2 patients had taking oral hormonal contraception. Hypertension is found in 5 patients at the time of diagnosis of TAKAYASU's disease. It was secondary to bilateral stenosis of the renal arteries in one patient. 53% pregnancies are carried to term without fetal complications in 5 patients with inactive TAKAYASU vasculitis during their pregnancies, 23% were complicated by fetal death in utero,15% termination of pregnancy (voluntary and therapeutic and spontaneous), and 12.5% growth retardation in utero. 3 (33%) patients presented with pre-eclampsia, and one (10%) patient presented with pregnancy-induced hypertension and another patient (10%) had a hemorrhagic stroke. Only one premature delivery was performed in front of a fetal distress by caesarean section. The vaginal delivery was ensured in 45.83%, and the caesarean in 8.3%. Fetal extraction was performed vaginally for death feat in utero and pregnancy terminations. The pregnancy was responsible for a flare-up of TAKAYASU's vasculitis which went from an inactive status (NIH stage 1-2) to an active status (NIH stage 3-4) in 2/10 (20%) of the patients and was statistically linked to relapse with a significant p (p=0.009). TAKAYASU vasculitis type I was predominant (50%) followed by type V (30%).Statistical analysis showed a statistically significant link between pregnancy and carotid artery disease (P= 0.01). 8/10 patients (80%) were treated by corticosteroids and platelet aggregation inhibitor during 13/24 pregnancies (54.16%). Before the pregnancies, 7 patients had received immunosuppressive treatment such as methotrexate, cyclophosphamide in one patient and another was treated by adalumimab. Only 5 patients needed recourse to immunosuppressive therapy during their pregnancies (azathioprine). Statistical analyzes objectified a significant link between pregnancy and the use of azathioprine (p= 0.02). 4 patients received antihypertensive treatment; one patient had undergone vascular surgery for bilateral stenosis of the renal arteries. Conclusion: TAKAYASU's vasculitis does not affect the fertility of patients with this disease. But a pregnancy carried out during the progressive form of this vasculitis can be responsible for serious maternal and fetal complications. Our study suggests links between pregnancy and relapse of TAKAYASU vasculitis, TAKAYASU's type I protective factor, and the interest of using azathioprine during pregnancies evolving on active TAKAYASU vasculitis. We propose an internist-obstetrician collaboration in order to better manage this delicate medical situation on the maternal and fetal medical strategy.