Pregnant women with Takayasu's arteritis and their babies are at high risk for serious complications

New research presented this week at ACR Convergence, the American College of Rheumatology's annual meeting, shows that pregnant women with Takayasu's arteritis, a type of large-vessel vasculitis, appear to have a high prevalence of serious maternal and fetal adverse outcomes. Through their pregnancy and delivery, these patients must have careful monitoring by a multidisciplinary medical team.

Takayasu's arteritis is more common in women, and it involves inflammation in the walls of the body's largest arteries, the aorta and its main branches. The disease results from an attack by the body's own immune system, causing inflammation in the walls of arteries. The inflammation leads to narrowing of the arteries, and this can reduce blood flow to many parts of the body.

About 90% of patients diagnosed with Takayasu's arteritis are under 30. Previous research suggests that the disease is associated with adverse pregnancy outcomes, including pre-eclampsia, but specific prevalence of these complications was unclear. Researchers conducted a systematic review and meta-analysis of multiple studies to find out more.

"The goal of this study was to look for the prevalence of maternal and fetal complications during pregnancy for patients with Takayasu's arteritis. As a result, we did not assess for any connection between prednisolone use and adverse maternal or fetal outcomes," says Aine Gorman, MD, a rheumatology trainee at Trinity College in Dublin, Ireland and the study's co-author.

Researchers collected data from 23 studies that reported on pregnancy outcomes in patients with Takayasu's arteritis published through March 2021. They pulled out demographic information on patients, maternal and fetal outcomes, use of the glucocorticoid drug prednisolone and data on patients' disease activity. Two authors independently selected the studies used, extracted the data and assessed it for any risk of bias.

The results highlighted serious concerns for patients with Takayasu's. They had a miscarriage rate of 11% and an intrauterine death rate of 1%. Preterm delivery occurred in 15% of these patients, new hypertension during pregnancy developed in 12% of cases, and intrauterine growth restriction happened in 16% of these pregnancies. In addition, 28% of pregnant patients with Takayasu's required delivery by cesarean section, and 16% of the babies born alive were of low birth weight. The study also found that 11% of pregnant women with Takayasu's had vasculitis flares. Across the time periods of these studies, from 1982-2020, the prevalence of preterm birth, pre-eclampsia and cesarean section rates all increased.

"This study's findings highlight the importance of having a multidisciplinary team approach when a Takayasu's arteritis patient is pregnant, with input required by multiple healthcare professionals. These patients look to have a high prevalence of serious maternal and fetal complications and should be carefully monitored for flares and complications during their pregnancies and delivery," said Dr. Gorman.