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Pregnancy in Systemic Vasculitis

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Women's Health in Autoimmune Diseases

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Abstract

Conception, pregnancy and childbirth are a biological necessity, a unique privilege and birthright and yet something that mothers suffering with vasculitis cannot take for granted. Takayasu arteritis and Behcet’s disease mainly, but also ANCA associated vasculitis and IgA vasculitis are of relevance in this population. A diagnosis of systemic vasculitis has meant a lower chance of stable relationships, lower fertility, lower conception rates and worse foetal outcomes. Systemic vasculitis or it’s treatment may affect fertility by direct involvement of the reproductive organs, teratogenicity, induced infertility, or by producing a state inducing an inability of the maternal body to carry a foetus to term. Unfortunately, there is sometimes the need for medical termination. Pregnancy outcomes are poorer in women with a diagnosis of vasculitis, but this may be truer for women with Takayasu arteritis than Behcet’s disease. In spite of the many challenges in looking after expectant mothers with systemic vasculitis, we suggest some basic principles in this chapter to improve maternal and foetal outcomes. This is largely an evidence-free zone and this stream of medicine involving motherhood, babies and life-threatening rare diseases will remain emotive and therefore difficult, calling for the best that clinicians can offer.

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References

  1. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F et al (2013) 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 65(1):1–11

    Article  CAS  PubMed  Google Scholar 

  2. Guillevin L, Mukhtyar C, Pagnoux C, Yates M (2018) Conventional and biological immunosuppressants in vasculitis. Best Pract Res Clin Rheumatol 32(1):94–111

    Article  PubMed  Google Scholar 

  3. Mukhtyar C, Hellmich B, Jayne D, Flossmann O, Luqmani R (2006) Remission in antineutrophil cytoplasmic antibody-associated systemic vasculitis. Clin Exp Rheumatol 24(6):S93

    Google Scholar 

  4. Mukhtyar CB, Flossmann O, Luqmani RA (2006) Clinical and biological assessment in systemic necrotizing vasculitides. Clin Exp Rheumatol 24(2 Suppl 41):S92–S99

    CAS  PubMed  Google Scholar 

  5. Walsh M, Mukhtyar C, Mahr A, Herlyn K, Luqmani R, Merkel PA et al (2011) Health-related quality of life in patients with newly diagnosed antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res (Hoboken) 63(7):1055–1061

    Article  Google Scholar 

  6. Pathak H, Mukhtyar C (2016) Pregnancy and systemic vasculitis. Indian J Rheumatol 11(6):145

    Article  Google Scholar 

  7. McDuffie FC (1985) Morbidity impact of rheumatoid arthritis on society. Am J Med 78(1A):1–5

    Article  CAS  PubMed  Google Scholar 

  8. Pagnoux C, Mahendira D, Laskin CA (2013) Fertility and pregnancy in vasculitis. Best Pract Res Clin Rheumatol 27(1):79–94

    Article  PubMed  Google Scholar 

  9. MacLean MA, Wilson R, Thomson JA, Krishnamurthy S, Walker JJ (1992) Immunological changes in normal pregnancy. Eur J Obstet Gynecol Reprod Biol 43(3):167–172

    Article  CAS  PubMed  Google Scholar 

  10. van der Horst-Bruinsma IE, de Vries RR, de Buck PD, van Schendel PW, Breedveld FC, Schreuder GM et al (1998) Influence of HLA-class II incompatibility between mother and fetus on the development and course of rheumatoid arthritis of the mother. Ann Rheum Dis 57(5):286–290

    Article  PubMed  Google Scholar 

  11. Østensen M, Förger F, Nelson JL, Schuhmacher A, Hebisch G, Villiger PM (2005) Pregnancy in patients with rheumatic disease: anti-inflammatory cytokines increase in pregnancy and decrease post-partum. Ann Rheum Dis 64(6):839–844

    Article  PubMed  Google Scholar 

  12. Wegmann TG, Lin H, Guilbert L, Mosmann TR (1993) Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunol Today 14(7):353–356

    Article  CAS  PubMed  Google Scholar 

  13. Kariv R, Sidi Y, Gur H (2000) Systemic vasculitis presenting as a tumorlike lesion. Four case reports and an analysis of 79 reported cases. Medicine (Baltimore) 79(6):349–359

    Article  CAS  Google Scholar 

  14. Suo L, Perez LC, Finch CJ (2019) Testicular granulomatous vasculitis mimicking testicular torsion in an anti-neutrophil cytoplasmic antibody-associated vasculitis patient. SAGE Open Med Case Rep 7. https://doi.org/10.1177/2050313X18823451

  15. Barber TD, Al-Omar O, Poulik J, McLorie GA (2006) Testicular infarction in a 12-year-old boy with Wegener’s granulomatosis. Urology 67(4):846.e9–846.10

    Article  Google Scholar 

  16. Rengasamy P (2017) Congenital malformations attributed to prenatal exposure to cyclophosphamide. Anti-Cancer Agents Med Chem 17(9):1211–1227

    Article  CAS  Google Scholar 

  17. Clowse ME, Copland SC, Hsieh TC, Chow SC, Hoffman GS, Merkel PA et al (2011) Ovarian reserve diminished by oral cyclophosphamide therapy for granulomatosis with polyangiitis (Wegener’s). Arthritis Care Res (Hoboken) 63(12):1777–1781

    Article  CAS  Google Scholar 

  18. Slater CA, Liang MH, McCune JW, Christman GM, Laufer MR (1999) Preserving ovarian function in patients receiving cyclophosphamide. Lupus 8(1):3–10

    Article  CAS  PubMed  Google Scholar 

  19. Ding J, Shang X, Zhang Z, Jing H, Shao J, Fei Q et al (2017) FDA-approved medications that impair human spermatogenesis. Oncotarget 8(6):10714–10725

    Article  PubMed  Google Scholar 

  20. Kumar A, Mohan A, Gupta R, Singal VK, Garg OP (1998) Relapse of Wegener’s granulomatosis in the first trimester of pregnancy: a case report. Br J Rheumatol 37(3):331–333

    Google Scholar 

  21. Pagnoux C, Le Guern V, Goffinet F, Diot E, Limal N, Pannier E et al (2011) Pregnancies in systemic necrotizing vasculitides: report on 12 women and their 20 pregnancies. Rheumatology (Oxford) 50(5):953–961

    Article  Google Scholar 

  22. Hidaka N, Yamanaka Y, Fujita Y, Fukushima K, Wake N (2012) Clinical manifestations of pregnancy in patients with Takayasu arteritis: experience from a single tertiary center. Arch Gynecol Obstet 285(2):377–385

    Article  PubMed  Google Scholar 

  23. Sangle SR, Vounotrypidis P, Briley A, Nel L, Lutalo PM, Sanchez-Fernandez S et al (2015) Pregnancy outcome in patients with systemic vasculitis: a single-centre matched case-control study. Rheumatology (Oxford) 54(9):1582–1586

    Article  Google Scholar 

  24. Croft AP, Smith SW, Carr S, Youssouf S, Salama AD, Burns A et al (2015) Successful outcome of pregnancy in patients with anti-neutrophil cytoplasm antibody-associated small vessel vasculitis. Kidney Int 87(4):807–811

    Article  PubMed  Google Scholar 

  25. Jordan NP, Bezanahary H, D’Cruz DP (2015) Increased risk of vascular complications in Takayasu’s arteritis patients with positive lupus anticoagulant. Scand J Rheumatol 44(3):211–214

    Article  CAS  PubMed  Google Scholar 

  26. Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K et al (2016) BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding—part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford) 55(9):1693–1697

    Article  CAS  Google Scholar 

  27. Mandal D, Mandal S, Dattaray C, Banerjee D, Ghosh P, Ghosh A et al (2012) Takayasu arteritis in pregnancy: an analysis from eastern India. Arch Gynecol Obstet 285(3):567–571

    Article  PubMed  Google Scholar 

  28. Comarmond C, Mirault T, Biard L, Nizard J, Lambert M, Wechsler B et al (2015) Takayasu arteritis and pregnancy. Arthritis Rheumatol 67(12):3262–3269

    Article  CAS  PubMed  Google Scholar 

  29. Ben-Chetrit E (2014) Behcet’s syndrome and pregnancy: course of the disease and pregnancy outcome. Clin Exp Rheumatol 32(4 Suppl 84):S93–S98

    PubMed  Google Scholar 

  30. Noel N, Wechsler B, Nizard J, Costedoat-Chalumeau N, Boutin d LT, Dommergues M et al (2013) Behcet’s disease and pregnancy. Arthritis Rheum 65(9):2450–2456

    Article  CAS  PubMed  Google Scholar 

  31. Yates M, Watts RA, Bajema IM, Cid MC, Crestani B, Hauser T et al (2016) EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis 75(9):1583–1594

    Article  CAS  PubMed  Google Scholar 

  32. Dayoan ES, Dimen LL, Boylen CT (1998) Successful treatment of Wegener’s granulomatosis during pregnancy: a case report and review of the medical literature. Chest 113(3):836–838

    Article  CAS  PubMed  Google Scholar 

  33. Sangle SR, Lutalo PM, Davies RJ, Khamashta MA, D’Cruz DP (2013) B-cell depletion therapy and pregnancy outcome in severe, refractory systemic autoimmune diseases. J Autoimmun 43:55–59

    Article  CAS  PubMed  Google Scholar 

  34. Diav-Citrin O, Otcheretianski-Volodarsky A, Shechtman S, Ornoy A (2014) Pregnancy outcome following gestational exposure to TNF-alpha-inhibitors: a prospective, comparative, observational study. Reprod Toxicol 43:78–84

    Article  CAS  PubMed  Google Scholar 

  35. Jayne DR, Chapel H, Adu D, Misbah S, O’Donoghue D, Scott D et al (2000) Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity. QJM 93(7):433–439

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Sir H N Reliance Foundation Hospital, Mumbai, India

    Puneet Mashru

  2. Norfolk and Norwich University Hospital, Norwich, UK

    Chetan Mukhtyar

  3. University of East Anglia, Norwich, UK

    Chetan Mukhtyar

Authors
  1. Puneet Mashru
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  2. Chetan Mukhtyar
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Correspondence to Chetan Mukhtyar .

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Editors and Affiliations

  1. Department of Internal Medicine, PGIMER, Chandigarh, India

    Shefali Khanna Sharma

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Mashru, P., Mukhtyar, C. (2020). Pregnancy in Systemic Vasculitis. In: Sharma, S. (eds) Women's Health in Autoimmune Diseases. Springer, Singapore. https://doi.org/10.1007/978-981-15-0114-2_14

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  • DOI: https://doi.org/10.1007/978-981-15-0114-2_14

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  • Online ISBN: 978-981-15-0114-2

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