Pregnancy and vasculitis, case series

Abstract

In patients with positive Antineutrophil Cytoplasmic Antibody (ANCA) vasculitis, both maternal and fetal outcomes may be compromised by disease activity and medication used; however, being pathologies of low prevalence, there are few descriptions in the literature. To reduce these risks, pregnancies should be planned after achieving sustained remission or low disease activity for at least 6 months.

The aim of this investigation was to describe maternal and fetal pregnancy outcomes in patients with vasculitis.

Case 1: A 25 years old woman with granulomatosis with polyangiitis, 5 years of evolution, upper airway involvement, retro orbital pseudotumor, lumbar back tumor of giant cells, pericarditis, pulmonary nodules and diabetes insipidus. She had 2 unplanned pregnancies after the diagnosis of vasculitis. She required cyclophosphamide 6 months before to pregnancy n ° 2, during which she was treated with Azathioprine. Cesarean section scheduled at 37 weeks (W) for oligoamnios, appropriate for gestational age (AGA) neonate. Pregnancy n ° 3 without previous activation, with equal treatment, without maternal or fetal complications, cesarean section due to previous cesarean section in W38, AGA neonate. Case 2: A 28 years old woman with Microscopic Polyangiitis (ANCA P +, MPO +) at 21 years old, pulmonary and renal involvement. It required Cyclophosphamide, Azathioprine and Rituximab. Rituximab suspended for family planning, changing to Azathioprine. W14: elevation of proteinuria with normal renal function, ANCA negative, normal Doppler at W12. W20 due to persistent proteinuria, the dose of corticosteroid is increased. Pulmonary maturation at W31 due to edema and increased proteinuria with preserved renal function and hypertension, treated with corticosteroids, azathioprine, antihypertensives and magnesium sulfate. Complications: steroid versus gestational diabetes, cholestasis. W34 due to renal failure, cesarean section is performed, AGA neonate. She recovery her renal function in the puerperium.

Although pregnancies in patients with vasculitis are high risk, in our small series those who attended with disease activity had complications, however maternal and fetal outcomes were favorable. Multidisciplinary follow-up by the rheumatologist and obstetrician is essential to achieve maternal fetal well-being.