Obstetric and perinatal outcomes in pregnant women with Takayasu’s arteritis: single centre experience over five years

Abstract

Objective: To study obstetric and perinatal outcomes among pregnant women with Takayasu arteritis (TA), attending our hospital for pregnancy and childbirth between January 2011 to December 2016.

Material and methods: Retrospective study was carried out by abstracting clinical charts on all pregnant women with TA who underwent antenatal care and/or delivery in our hospital during this period. American College of Rheumatology criteria was used for diagnosis of TA. Sixteen women with TA were included in the study. Maternal demographic data, stage of disease, complications related to disease, details of treatment taken prior to pregnancy, pregnancy outcomes, and neonatal outcomes were studied.

Results: Forty-four percentage (7/16) belonged to type 5 angiographic type, however the same proportion (7/16) had undergone surgical corrections prior to pregnancy and the majority (15/16) were on medical management. Only three women (19%) were diagnosed during pregnancy. Most did not have active disease measured by Kerr’s criteria (n=12; 75%), and Indıan Takayasu clinical activity scores A. Chronic hypertension was the commonest antenatal complication (56.2%), nearly one-third had growth restricted babies and 25% had preterm labour. There were no cardiovascular events, no maternal deaths, nor fetal or neonatal deaths. Two-thirds of our women were delivered by caesarean section.

Conclusion: Preconceptional counselling is of paramount importance in women with TA. Good maternal and fetal outcomes are observed with close antenatal surveillance and multidisciplinary care. Pregnancy should be planned during disease remission, with good antenatal care, close monitoring of clinical symptoms, early diagnosis and treatment of complications.

Keywords: Takayasu’s arteritis; periconceptional counselling; vasculitis; chronic hypertension; high risk pregnancy.

Figure 1

Flow diagram of clinical management in pregnant women with TA ACR: American College of Rheumatology, APLA: Anti-phospholipid antibody, KFTS: Kidney function tests, CRP: C-reactive protein, ESR: Erythrocyte sedimentation rate, LDA: Low dose aspirin, ITAS: Indian Takayasu arteritis society, FGR: Fetal growth restriction, GTT: Glucose tolerance test, FGR: Fetal growth restriction