Skip to main content
SpringerLink
Log in

Vasculitis and Pregnancy

  • Chapter
  • First Online:
Contraception and Pregnancy in Patients with Rheumatic Disease

  • 721 Accesses

Abstract

Several of the primary systemic vasculitides including those involving large, medium, and small blood vessels can affect women of childbearing age. In approaching pregnancy in any woman with an underlying primary vasculitis, thorough assessment of disease activity and prior damage is crucial. In all forms of vasculitis, both maternal and fetal outcomes are optimized when the vasculitis is in remission at the time of conception. While the data are limited, pregnancy itself does not seem to cause disease flares in the majority of women with any of the primary vasculitides. Rates of maternal complications vary depending on the type of vasculitis, with most maternal complications related to sequelae of prior vasculitis in the form of hypertension, renal insufficiency, or airway disease. There are few reports of transient manifestations of vasculitis in neonates, presumed to be related to trans-placental transfer of antibodies, all of which were self-limited.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Clowse ME, Richeson RL, Pieper C, Merkel PA. Pregnancy outcomes among patients with vasculitis. Arthritis Care Res (Hoboken). 2013;65(8):1370–4.

    Article  Google Scholar 

  2. Geirsson AJ, Sturfelt G, Truedsson L. Clinical and serological features of severe vasculitis in rheumatoid arthritis: prognostic implications. Ann Rheum Dis. 1987;46:727.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  3. Ramos-Casals M, Nardi N, Lagrutta M, Brito-Zerón P, Bové A, Delgado G, Cervera R, Ingelmo M, Font J. Vasculitis in systemic lupus erythematosus: prevalence and clinical characteristics in 670 patients. Medicine (Baltimore). 2006;85(2):95–104.

    Article  Google Scholar 

  4. Brito-Zerón P, Ramos-Casals M, Bove A, Sentis J, Font J. Predicting adverse outcomes in primary Sjögren’s syndrome: identification of prognostic factors. Rheumatology. 2007;46:1359–62.

    Article  PubMed  Google Scholar 

  5. Pavlakis PP, Alexopoulos H, Kosmidis ML, Mamali I, Moutsopoulos HM, Tzioufas AG, Dalakas MC. Peripheral neuropathies in Sjögren’s syndrome: a critical update on clinical features and pathogenetic mechanisms. J Autoimmun. 2012;39(1–2):27–33.

    Article  PubMed  CAS  Google Scholar 

  6. Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE. Takayasu’s arteritis. Clinical study of 107 cases. Am Heart J. 1977;93(1):94.

    Article  PubMed  CAS  Google Scholar 

  7. Johnston SL, Lock RJ, Gompels MM. Takayasu arteritis: a review. J Clin Pathol. 2002;55(7): 481–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. Suri V, Aggarwal N, Keepanasseril A, Chopra S, Vijayvergiya R, Jain S. Pregnancy and Takayasu arteritis: a single centre experience from North India. J Obstet Gynaecol Res. 2010;36(3):519–24.

    Article  PubMed  Google Scholar 

  9. Gatto M, Iaccarino L, Canova M, Zen M, Nalotto L, Ramonda R, Punzi L, Doria A. Pregnancy and vasculitis: a systematic review of the literature. Autoimmun Rev. 2012;11(6–7): A447–59.

    Article  PubMed  Google Scholar 

  10. Langford CA, Kerr GS. Pregnancy in vasculitis. Curr Opin Rheumatol. 2002;14(1):36–41.

    Article  PubMed  Google Scholar 

  11. Sharma BK, Jain S, Vasishta K. Outcome of pregnancy in Takayasu arteritis. Int J Cardiol. 2000;75 Suppl 1:S159–62.

    Article  PubMed  Google Scholar 

  12. Manika A, Ananya D. Pregnancy in Takayasu’s arteritis with bilateral renal artery and abdominal aorta stents. Aust N Z J Obstet Gynaecol. 2010;50(2):203–4.

    Article  PubMed  Google Scholar 

  13. Tomioka N, Hirose K, Abe E, Miyamoto N, Araki K, Nomura R, Ishikawa K. Indications for peripartum aortic pressure monitoring in Takayasu’s disease. A patient with past history of intrapartum cerebral hemorrhage. Jpn Heart J. 1998;39(2):255–60.

    Article  PubMed  CAS  Google Scholar 

  14. Wong VCW, Yang RYC, Tse TF. Pregnancy and Takayasu’s arteritis. Am J Med. 1983;75:597–601.

    Article  PubMed  CAS  Google Scholar 

  15. Kathirvel S, Chavan S, Arya VK, Rehman I, Babu V, Malhotra N, Bhukal I, Chari P. Anesthetic management of patients with Takayasu’s arteritis: a case series and review. Anesth Analg. 2001;93(1):60–5.

    Article  PubMed  CAS  Google Scholar 

  16. Ishikawa K, Matsuura S. Occlusive thromboaortopathy (Takayasu’s disease) and pregnancy. Clinical course and management of 33 pregnancies and deliveries. Am J Cardiol. 1982;50(6):1293–300.

    Article  PubMed  CAS  Google Scholar 

  17. Duhaut P, Pinède L, Demolombe-Ragué S, et al. Giant cell arteritis and polymyalgia rheumatica: are pregnancies a protective factor? A prospective, multicentre case–control study. GRACG (Groupe de Recherche sur l’Artérite à Cellules Géantes). Rheumatology (Oxford). 1999;38(2):118–23.

    Article  CAS  Google Scholar 

  18. Pagnoux C, Seror R, Henegar C, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis Rheum. 2010;62(2):616.

    Article  PubMed  Google Scholar 

  19. Basu N, Watts R, Bajema I, et al. EULAR points to consider in the development of classification and diagnostic criteria in systemic vasculitis. Ann Rheum Dis. 2010;69:1744–50.

    Article  PubMed  Google Scholar 

  20. Stone JH. Vasculitis: a collections of pearls and myths. Rheum Dis Clin North Am. 2007;33:691–739.

    Article  PubMed  Google Scholar 

  21. Owen J, Hauth JC. Polyarteritis nodosa in pregnancy: a case report and brief literature review. Am J Obstet Gynecol. 1989;160:606–7.

    Article  PubMed  CAS  Google Scholar 

  22. Fernandes SR, Cury CP, Samara AM. Pregnancy with a history of treated polyarteritis nodosa. J Rheumatol. 1996;23:1119–20.

    PubMed  CAS  Google Scholar 

  23. Nagey DA, Fortier KJ, Linder J. Pregnancy complicated by periarteritis nodosa: induced abortion as an alternative. Am J Obstet Gynecol. 1983;147:103–5.

    PubMed  CAS  Google Scholar 

  24. Burkett G, Richards R. Periarteritis nodosa and pregnancy. Obstet Gynecol. 1982;59:252–4.

    PubMed  CAS  Google Scholar 

  25. Stone JH, Merkle PA, Spiera R, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010;363(3):221–32.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  26. Clowse ME, Copland SC, Hsieh TC, et al. Ovarian reserve is diminished by oral cyclophosphamide therapy for granulomatosis with polyangiitis (Wegener’s). Arthritis Care Res (Hoboken). 2011;63(12):1777–81.

    Article  CAS  Google Scholar 

  27. Hoffman GS, Kerr GS, Leavitt RY, et al. Wegener’s granulomatosis: an analysis of 158 patients. Ann Intern Med. 1992;116:488–98.

    Article  PubMed  CAS  Google Scholar 

  28. The WGET Research Group. Etanercept in addition to standard therapy in patients with Wegener’s granulomatosis. N Engl J Med. 2005;352:19–29.

    Article  Google Scholar 

  29. Devakumar VN, Castelino M, Chow SC, Teh LS. Wegener’s granulomatosis in pregnancy: a case report and review of the medical literature. BMJ Case Rep. 2010. doi:10.1136/bcr.09.2009.2296.

  30. Tuin J, Sanders JS, de Joode AA, Stegeman CA. Pregnancy in women diagnosed with antineutrophil cytoplasmic antibody-associated vasculitis: outcome for the mother and the child. Arthritis Care Res (Hoboken). 2012;64(4):539–45.

    Article  CAS  Google Scholar 

  31. Auzary C, Huong DT, Wechsler B, Vauthier-Brouzes D, Piette JC. Pregnancy in patients with Wegener’s granulomatosis: report of five cases in three women. Ann Rheum Dis. 2000;59(10):800–4.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  32. Alfhaily F, Watts R, Leather A. Wegener’s granulomatosis occurring de novo during pregnancy. Clin Exp Rheumatol. 2009;27(1 Suppl 52):S86–8.

    PubMed  CAS  Google Scholar 

  33. Langford CA, Sneller MC, Hallahan CW, Hoffman GS, Kammerer WA, Talar-Williams C, Fauci AS, Lebovics RS. Clinical features and therapeutic management of subglottic stenosis in patients with Wegener’s granulomatosis. Arthritis Rheum. 1996;39(10):1754–60.

    Article  PubMed  CAS  Google Scholar 

  34. Masterson R, Pellicano R, Bleasel K, McMahon LP. Wegener’s granulomatosis in pregnancy: a novel approach to management. Am J Kidney Dis. 2004;44(4):e68–72.

    Article  PubMed  Google Scholar 

  35. Sangle SR, Lutalo PM, Davies RJ, et al. B-cell depletion therapy and pregnancy outcome in severe, refractory systemic autoimmune diseases. J Autoimmun. 2013;43:55–9.

    Article  PubMed  CAS  Google Scholar 

  36. Milne KL, Stanley KP, Temple RC, Barker TH, Ross CN. Microscopic polyangiitis: first report of a case with onset during pregnancy. Nephrol Dial Transplant. 2004;19(1):234–7.

    Article  PubMed  Google Scholar 

  37. Porres-Aguilar M, Figueroa-Casas JB, Porres-Muñoz M, Elliott CG. A 38-year-old pregnant woman with hemoptysis and acute renal failure. Respiration. 2011;82:60–4.

    Article  PubMed  Google Scholar 

  38. Cetinkaya R, Odabas AR, Gursan N, Selcuk Y, Erdogan F, Keles M, Kumtepe Y. Microscopic polyangiitis in a pregnant woman. South Med J. 2002;95(12):1441–3.

    Article  PubMed  Google Scholar 

  39. Yamashita Y, Yamane K, Fujikawa R, Okubo M, Kohno N. A successful pregnancy and delivery case of Graves’ disease with myeloperoxidase antineutrophil cytoplasmic antibody induced by propylthiouracil. Endocr J. 2002;49(5):555–9.

    Article  PubMed  Google Scholar 

  40. Kimura M, Seki T, Ozawa H, Ishihara T, Komatsu M, Tajiri S, Yanagi H, Nishina M, Noh JY, Fukagawa M, Takagi A. The onset of antineutrophil cytoplasmic antibody-associated vasculitis immediately after methimazole was switched to propylthiouracil in a woman with Graves’ disease who wished to become pregnant. Endocr J. 2013;60(3):383–8. Epub 16 Nov 2012.

    Article  PubMed  CAS  Google Scholar 

  41. Schlieben DJ, Korbet SM, Kimura RE, Schwartz MM, Lewis EJ. Pulmonary-renal syndrome in a newborn with placental transmission of ANCAs. Am J Kidney Dis. 2005;45:758–61.

    Article  PubMed  Google Scholar 

  42. Silva F, Specks U, Sethi S, Irazabal MV, Fervenza FC. Successful pregnancy and delivery of a healthy newborn despite transplacental transfer of antimyeloperoxidase antibodies from a mother with microscopic polyangiitis. Am J Kidney Dis. 2009;54:542–5.

    Article  PubMed  Google Scholar 

  43. Comarmond C, Pagnoux C, Khellaf M, Cordier JF, Hamidou M, Viallard JF, Maurier F, Jouneau S, Bienvenu B, Puéchal X, Aumaître O, Le Guenno G, Le Quellec A, Cevallos R, Fain O, Godeau B, Seror R, Dunogué B, Mahr A, Guilpain P, Cohen P, Aouba A, Mouthon L, Guillevin L, French Vasculitis Study Group. Eosinophilic granulomatosis with polyangiitis (Churg–Strauss): clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort. Arthritis Rheum. 2013;65(1):270–81.

    Article  PubMed  Google Scholar 

  44. Debby A, Tanay A, Zakut H. Allergic granulomatosis and angiitis (Churg–Strauss vasculitis) in pregnancy. Int Arch Allergy Immunol. 1993;102:307–8.

    Article  PubMed  CAS  Google Scholar 

  45. Cormio G, Cramarossa D, Di Vagno G, et al. Successful pregnancy in a patient with Churg–Strauss syndrome. Eur J Obstet Gynecol Reprod Biol. 1995;60:81–3.

    Article  PubMed  CAS  Google Scholar 

  46. Ogasawara M, Kajiura S, Inagaki H, et al. Successful pregnancy in a Churg–Strauss syndrome patient with a history of intrauterine fetal death. Int Arch Allergy Immunol. 1995;108:200–2.

    Article  PubMed  CAS  Google Scholar 

  47. Pagnoux C, Le Guern V, Goffinet F, Diot E, Limal N, Pannier E, Warzocha U, Tsatsaris V, Dhote R, Karras A, Cohen P, Damade R, Mouthon L, Guillevin L. Pregnancies in systemic necrotizing vasculitides: report on 12 women and their 20 pregnancies. Rheumatology (Oxford). 2011;50(5):953–61.

    Article  Google Scholar 

  48. Barry C, Davis S, Garrard P, et al. Churg–Strauss disease: deterioration in a twin pregnancy. Successful outcome following treatment with corticosteroids and cyclophosphamide. Br J Obstet Gynaecol. 1997;104:746–7.

    Article  PubMed  CAS  Google Scholar 

  49. Priori R, Tomassini M, Magrini L, Conti F, Valesini G. Churg–Strauss syndrome during pregnancy after steroid withdrawal. Lancet. 1998;352(9140):1599–600.

    Article  PubMed  CAS  Google Scholar 

  50. Hot A, Perard L, Coppere B, Simon M, Bouhour F, Ninet J. Marked improvement of Churg–Strauss vasculitis with intravenous gamma globulins during pregnancy. Clin Rheumatol. 2007;26:2149–51.

    Article  PubMed  Google Scholar 

  51. Connolly JO, Lanham JG, Partridge MR. Fulminant pregnancy-related Churg–Strauss syndrome. Br J Rheumatol. 1994;33:776–7.

    Article  PubMed  CAS  Google Scholar 

  52. Corradi D, Maestri R, Facchetti F. Postpartum Churg–Strauss syndrome with severe cardiac involvement: description of a case and review of the literature. Clin Rheumatol. 2009;28(6):739–43.

    Article  PubMed  Google Scholar 

  53. Agnello V, Chung RT, Kaplan LM. A role for hepatitis C virus infection in type II cryoglobulinemia. N Engl J Med. 1992;327(21):1490.

    Article  PubMed  CAS  Google Scholar 

  54. Alberico S, Mazza S, Grimaldi E, Volpe C, Guaschino S. Essential mixed type II cryoglobulinemia in a HCV positive pregnant woman: case report. Clin Exp Obstet Gynecol. 1998;25(4):129–31.

    PubMed  CAS  Google Scholar 

  55. Gupta A, Gupta G, Marouf R. Cryoglobulinemic vasculitis in pregnancy. Int J Gynaecol Obstet. 2008;103(2):177–8.

    Article  PubMed  Google Scholar 

  56. Juverdeanu S, Soydemir F, Baker P. Successful outcome of a pregnancy complicated by type 3 cryoglobulinaemia with negative hepatitis C virus (HCV) serology. J Obstet Gynaecol. 2008;28(2):233–4.

    Article  PubMed  CAS  Google Scholar 

  57. Sibilia J, Feugeas O, Laugel V, Dreval A, Messer J, Goetz J. Successful management of neonatal cryoglobulinaemia after a gemellar pregnancy in a woman with symptomatic type I cryoglobulinaemia. Ann Rheum Dis. 2004;63(2):217–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  58. Laugel V, Goetz J, Wolff S, Beladdale J, Sibilia J, Messer J. Neonatal management of symptomatic transplacental cryoglobulinaemia. Acta Paediatr. 2004;93(4):556–8.

    Article  PubMed  CAS  Google Scholar 

  59. Calamia KT, Wilson FC, Icen M, Crowson CS, Gabriel SE, Kremers HM. Epidemiology and clinical characteristics of Behçet’s disease in the US: a population-based study. Arthritis Rheum. 2009;61(5):600.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Uzun S, Alpsoy E, Durdu M, Akman A. The clinical course of Behçet’s disease in pregnancy: a retrospective analysis and review of the literature. J Dermatol. 2003;30(7):499–502.

    Article  PubMed  Google Scholar 

  61. Jadaon J, Shushan A, Ezra Y, Sela HY, Ozcan C, Rojansky N. Behçet’s disease and pregnancy. Acta Obstet Gynecol Scand. 2005;84(10):939.

    PubMed  Google Scholar 

  62. Cakal B, Koklu S, Beyazit Y, Ozdemir A, Beyazit F, Ulker A. Fatal colonic perforation in a pregnant with Behçet’s disease. J Crohns Colitis. 2011;5(3):273–4.

    Article  PubMed  Google Scholar 

  63. Diav-Citrin O, Shechtman S, Schwartz V, Avgil-Tsadok M, Finkel-Pekarsky V, Wajnberg R, Arnon J, Berkovitch M, Ornoy A. Pregnancy outcome after in utero exposure to colchicine. Am J Obstet Gynecol. 2010;203(2):144.e1–6.

    Google Scholar 

  64. Takayama K, Ishikawa S, Enoki T, Kojima T, Takeuchi M. Successful treatment with infliximab for Behçet disease during pregnancy. Ocul Immunol Inflamm. 2013;21(4):321–3.

    Article  PubMed  CAS  Google Scholar 

  65. Marchioni RM, Lichtenstein GR. Tumor necrosis factor-α inhibitor therapy and fetal risk: a systematic literature review. World J Gastroenterol. 2013;19(17):2591–602.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  66. Kale A, Akyildiz L, Akdeniz N, et al. Pregnancy complicated by superior vena cava thrombosis and pulmonary embolism in a patient with Behçet disease and the use of heparin for treatment. Saudi Med J. 2006;27:95–7.

    PubMed  Google Scholar 

  67. Thomas LA, Summers RR, Cardwell MS. Use of Greenfield filters in pregnant women at risk for pulmonary embolism. South Med J. 1997;90:215–7.

    Article  PubMed  CAS  Google Scholar 

  68. Fam AG, Siminvotch KA, Carette S, From L. Neonatal Behçet’s syndrome in an infant of a mother with the disease. Ann Rheum Dis. 1981;40(5):509–12.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  69. Stark AC, Bhakta B, Chamberlain MA, Dear P, Taylor PV. Life-threatening transient neonatal Behçets disease. Br J Rheumatol. 1997;36(6):700–2.

    Article  PubMed  CAS  Google Scholar 

  70. Chang YS, Yang YH, Chiang BL. Neonatal Behçet’s disease without maternal history. Clin Rheumatol. 2011;30(12):1641–5.

    Article  PubMed  Google Scholar 

  71. Chong SK, Wright VM, Nishigame T, Raafat F, Isaacs D, Morson BC, Walker-Smith JA. Infantile colitis: a manifestation of intestinal Behçet’s syndrome. J Pediatr Gastroenterol Nutr. 1988;7(4):622–7.

    Article  PubMed  CAS  Google Scholar 

  72. Hwang I, Lee CK, Yoo B, Lee I. Necrotizing villitis and decidual vasculitis in the placentas of mothers with Behçet disease. Hum Pathol. 2009;40(1):135–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Rheumatology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA

    Lindsay Lally M.D. & Robert F. Spiera M.D.

Authors
  1. Lindsay Lally M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert F. Spiera M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lindsay Lally M.D. .

Editor information

Editors and Affiliations

  1. Division of Rheumatology, Hospital for Special Surgery Weill Cornell Medical College, New York, New York, USA

    Lisa R. Sammaritano

  2. Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Bonnie L. Bermas

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Lally, L., Spiera, R.F. (2014). Vasculitis and Pregnancy. In: Sammaritano, L., Bermas, B. (eds) Contraception and Pregnancy in Patients with Rheumatic Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0673-4_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0673-4_9

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-0672-7

  • Online ISBN: 978-1-4939-0673-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation