Successful outcome of pregnancy in patients with anti-neutrophil cytoplasm antibody-associated small vessel vasculitis

Kidney Int. 2015 Apr;87(4):807-11. doi: 10.1038/ki.2014.329. Epub 2014 Oct 1.

Abstract

Pregnancy in patients with anti-neutrophil cytoplasm antibody-associated vasculitis is reportedly associated with a high risk of fetal and maternal complications. Here we describe the outcome of pregnancies in patients with granulomatosis with polyangiitis and microscopic polyangiitis at five centers in the United Kingdom using a retrospective case review of all women who became pregnant following diagnosis. We report 15 pregnancies in 13 women resulting in 15 live births including one twin pregnancy and 13 singleton pregnancies. One patient had an unplanned pregnancy and a first trimester miscarriage while taking methotrexate. All other pregnancies were planned following a minimum of 6 months clinical remission. Eleven successful pregnancies were delivered vaginally at full term, whereas three were delivered by cesarean section. All infants were healthy with no neonatal complications on their initial health check within the first 24 h of delivery and no evidence of neonatal vasculitis. One relapse occurred during pregnancy and was successfully treated with an increased dose of azathioprine and corticosteroids, intravenous immunoglobulin, and plasma exchange therapy. One patient developed tracheal crusting and subglottic stenosis of infective etiology in the third trimester requiring tracheal debridement post delivery. No patient had a relapse in the first 12 months postpartum. Thus, successful pregnancy outcomes can occur following planned pregnancy in women in sustained remission on non-teratogenic therapies.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Spontaneous / chemically induced
  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Azathioprine / therapeutic use
  • Cesarean Section
  • Cyclophosphamide / therapeutic use
  • Female
  • Granulomatosis with Polyangiitis / drug therapy*
  • Granulomatosis with Polyangiitis / therapy
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Live Birth
  • Methotrexate / adverse effects
  • Microscopic Polyangiitis / drug therapy*
  • Microscopic Polyangiitis / therapy
  • Plasma Exchange
  • Preconception Care
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Pregnancy Complications / therapy
  • Pregnancy, High-Risk
  • Pregnancy, Unplanned
  • Recurrence
  • Retrospective Studies
  • Term Birth
  • United Kingdom
  • Young Adult

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Immunosuppressive Agents
  • Cyclophosphamide
  • Azathioprine
  • Methotrexate