7Fertility and pregnancy in vasculitis
Section snippets
Fertility concerns in vasculitis patients
A significant concern in young women and men diagnosed with vasculitis is the potential impact on fertility. Often, in light of the potential life- and organ-threatening implications of vasculitis, implications for fertility are not immediately considered. However, health-care providers must identify and address this issue with patients at an early stage and certainly before pharmacologic management. The issue should be re-addressed when the patient discusses pregnancy. The patient's current
Conception in vasculitis patients
Ideally, pregnancy should be planned in consultation with the rheumatologist or other referring physician for vasculitis. Most centres for vasculitis and other systemic diseases have established collaborations with maternal foetal medicine obstetricians and/or specific programmes for managing such high-risk pregnancies. Patients who plan their pregnancies can thus be referred early to these dedicated clinics to optimise their chances of an uneventful pregnancy. A complete baseline assessment
Pregnancy in vasculitis and outcomes
More than 200 pregnancies have been reported in patients with TAK or Behçet's disease (Fig. 1); the average age at disease onset is 20–30 years and treatment primarily consists of corticosteroids (and/or colchicine for the latter disease). Fewer cases have been reported for GPA, MPA, EGPA or PAN because the age of diagnosis is about 50 years and requires, with severe disease, strong immunosuppressive regimens, usually with CYC. More recently, an Internet-based survey of patients with vasculitis
Summary
The incidence of vasculitis in people of childbearing age is relatively low, but fertility preservation counselling, as well as managing these potentially high-risk pregnancies, is important. Understanding and preparing for the potential impacts of pregnancy and the underlying vasculitis on each other are important for the best outcome. From the available data, most pregnancies in vasculitis have favourable outcomes for both the mother and the newborn. The pregnancy should be planned when
References (109)
Pregnancy and vasculitides
Presse Médicale
(2008)- et al.
Pregnancy and vasculitis: a systematic review of the literature
Autoimmunity Reviews
(2012) Pregnancy and vasculitis
Rheumatic Diseases Clinics of North America
(2007)- et al.
Occlusive thromboaortopathy (Takayasu's disease) and pregnancy. Clinical course and management of 33 pregnancies and deliveries
American Journal of Cardiology
(1982) - et al.
Polyarteritis nodosa presenting as acute orchitis: a case report and review of the literature
The Journal of Urology
(1993) - et al.
Orchitis mimicking testicular torsion in Henoch–Schonlein's purpura
The Journal of Urology
(1981) - et al.
Immunosuppressants for auto-immune diseases and pregnancy
Presse Med
(2008) - et al.
Giant cell arteritis and polymyalgia rheumatica: influence of past pregnancies? The GRACG multicenter case control study
La Revue de Medecine Interne/Fondee
(2004) - et al.
Cryoglobulinemic vasculitis in pregnancy
International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics
(2008) - et al.
Outcome of pregnancy in Takayasu arteritis
International Journal of Cardiology
(2000)