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Fertility and pregnancy in vasculitis

https://doi.org/10.1016/j.berh.2013.02.002Get rights and content

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.

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

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