Poor obstetric outcomes in women with takayasu arteritis: a retrospective cohort study

Springer Science and Business Media LLC
Erdal Bodakçı1, Döndü Üsküdar Cansu2, Cengiz Korkmaz2
1Division of Rheumatology, Department of Internal Medicine, Eskisehir State Hospıtal, Eskisehir, 26100, Turkey
2Division of Rheumatology, Faculty of Medicine, Department of Internal Medicine, Eskişehir Osmangazi University, 26480, Eskişehir, Turkey

Tóm tắt

AbstractThe objective of this study was to assess the pregnancy outcomes in a cohort of patients who experienced pregnancies before and/or after being diagnosed with Takayasu’s arteritis (TA). The present investigation encompassed a total of 88 pregnancies seen in a cohort of 35 patients who met the criteria outlined by the American College of Rheumatology in 1990 for the classification of Takayasu arteritis (TA). Pregnancies were classified into two categories. 1. Pregnancies that occurred before the diagnosis (pre-d or pre-TA) 2. Pregnancies that happened following a diagnosis (post-d or post-TA). Fifty-nine pregnancies (67.0%) occurred in 21 TA patients before the diagnosis with and a complication rate of 15.2%, and twenty-nine pregnancies (33.0%) occurred in 14 patients concomitant with or after TA diagnosis and complication rate 100%. Although the hypertension rate was higher in the pre-d group than in the post-d group, it was not significant (32.2% vs. 10.3%, p = 0.160). However, preeclampsia (20.6% vs. 0%, p = 0.001), low birth weight (27.5% vs. 1.6%, p = 0.001), and prematurity (24.1% vs. 1.6%, p = 0.035) were observed more frequently in the post-d group compared to the pre-d group. The frequency of abortions and in-utero deaths were similar in both groups (p > 0.05). Patients with hypertension had significantly higher rates of preeclampsia (p = 0.003), preterm birth (p = 0.036), low birth weight (p = 0.250), abortion (p = 0.018), in utero death (p = 0.128), and cesarean section (p = 0.005) than those without hypertension. Renal artery involvement was detected in 15 (42.8%) patients. All patients with renal artery involvement had hypertension, and they had significantly more pregnancy complications than the other group (p = 0.001). TA negatively affects pregnancy outcomes. A good control of arterial hypertension before conception and during pregnancy is critical to improve both maternal and fetal outcomes. In addition, detecting renal artery stenosis before pregnancy is important in reducing possible negative pregnancy outcomes.

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Tài liệu tham khảo

De Souza AWS, de Carvalho JF (2014) Diagnostic and classification criteria of takayasu arteritis. J Autoimmun 48–49:79–83. https://doi.org/10.1016/j.jaut.2014.01.012

Gudbrandsson B, Wallenius M, Garen T, Henriksen T, Molberg Ø, Palm Ø (2017) Takayasu arteritis and pregnancy: a population-based study on outcomes and mother/child-related concerns. Arthritis Care Res 69(9):1384–1390. https://doi.org/10.1002/acr.23146

Ross C, D’Souza R, Pagnoux C (2020) Pregnancy outcomes in systemic vasculitides. Curr Rheumatol Rep 22(10):63. https://doi.org/10.1007/s11926-020-00940-5

Troiano NH (2018) Physiologic and hemodynamic changes during pregnancy. AACN Adv Crit Care 29(3):273–283. https://doi.org/10.4037/aacnacc2018911

He S, Li Z, Zhang G, Song Y, Li J, Yang Y, Zhao J, Wang Y, Tian X, Zeng X (2022) Pregnancy outcomes in Takayasu arteritis patients. Semin Arthritis Rheum 55:152016. https://doi.org/10.1016/j.semarthrit.2022.152016

Gonenli MG, Kaymaz Tahra S, Kara M, Keser G, Yazıcı A, Alpay-Kanıtez N et al (2022) Pregnancy in Takayasu’s arteritis has a high risk of hypertension-related fetomaternal complications: a retrospective study of a Turkish cohort. Int J Rheum Dis 25(2):140–146. https://doi.org/10.1111/1756-185x.14247

Abisror N, Mekinian A, Hachulla E, Lambert M, Morel N, Chapelon C et al (2020) Analysis of risk factors for complications and adverse obstetrical outcomes in women with Takayasu arteritis: a French retrospective study and literature review. Clin Rheumatol 39(9):2707–2713. https://doi.org/10.1007/s10067-020-05024-4

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. https://doi.org/10.1002/art.39335

Singh N, Tyagi S, Tripathi R, Mala YM (2015) Maternal and fetal outcomes in pregnant women with Takayasu aortoarteritis: does optimally timed intervention in women with renal artery involvement improve pregnancy outcome? Taiwan J Obstet Gynecol 54(5):597–602. https://doi.org/10.1016/j.tjog.2015.08.014

Gupta L, Misra DP, Ahmed S, Jain A, Zanwar A, Lawrence A et al (2020) Poor obstetric outcomes in Indian women with Takayasu arteritis. Adv Rheumatol 60(1):17. https://doi.org/10.1186/s42358-020-0120-6

Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM et al (1990) The American college of rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33:1129–1134. https://doi.org/10.1002/art.1780330811

Hata A, Noda M, Moriwaki R, Numano F (1996) Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol 54(Suppl):S155-163. https://doi.org/10.1016/s0167-5273(96)02813-6

Mayer C, Joseph KS (2013) Fetal growth: a review of terms, concepts and issues relevant to obstetrics. Ultrasound Obstet Gynecol 41(2):136–145. https://doi.org/10.1002/uog.11204

Siddiqui F, Kean L (2009) Intrauterine fetal death. Obstet Gynaecol Reprod Med 19(1):1–6

Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS (1994) Takayasu arteritis. Ann Intern Med 120(11):919–929. https://doi.org/10.7326/0003-4819-120-11-199406010-00004

Makin K, Isbel M, Nossent J (2017) Frequency, presentation, and outcome of Takayasu arteritis in Western Australia. Mod Rheumatol 27(6):1019–1023. https://doi.org/10.1080/14397595.2017.1300083

Kirshenbaum M, Simchen MJ (2018) Pregnancy outcome in patients with Takayasu’s arteritis: cohort study and review of the literature. J Matern Fetal Neonatal Med 31:28772883. https://doi.org/10.1080/14767058.2017.1359529

Sato EI, Hatta FS, Levy-Neto M, Fernandes S (1998) Demographic, clinical, and angiographic data of patients with Takayasu arteritis in Brazil. Int J Cardiol 66(Suppl 1):67–70. https://doi.org/10.1016/s0167-5273(98)00152-1

Assad AP, da Silva TF, Bonfa E, Pereira RM (2015) Maternal and Neonatal Outcomes in 89 Patients with Takayasu Arteritis (TA): comparison Before and After the TA Diagnosis. J Rheumatol 42(10):1861–1864. https://doi.org/10.3899/jrheum.150030

Bharuthram N, Tikly M (2020) Pregnancy and Takayasu arteritis: case-based review. Rheumatol Int 40(5):799–809. https://doi.org/10.1007/s00296-019-04499-y

Suri V, Aggarwal N, Keepanasseril A, Chopra S, Vijayvergiya R, Jain S (2010) Pregnancy and Takayasu arteritis: a single centre experience from North India. J Obstet Gynaecol Res 36(3):519–524. https://doi.org/10.1111/j.1447-0756.2010.01226.x

David LS, Beck MM, Kumar M, Rajan SJ, Danda D, Vijayaselvi R (2020) Obstetric and perinatal outcomes in pregnant women with Takayasu’s arteritis: single centre experience over five years. J Turk Ger Gynecol Assoc 21(1):15–23

Comarmond C, Saadoun D, Nizard J, Cacoub P (2020) Pregnancy issues in Takayasu arteritis. Semin Arthritis Rheum. 50(5):911–914. https://doi.org/10.1016/j.semarthrit.2020.08.001

Quenby S, Gallos ID, Dhillon-Smith RK, Podesek M, Stephenson MD, Coomarasamy A et al (2021) Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet. https://doi.org/10.1016/S0140-6736(21)00682-6

Eryurt M, Adalı T, Türkyılmaz A, Çağatay P, Koç İ, Çavlin A and Keskin F (2019). Hacettepe University Institute of Population Studies, 2018 Turkey Demographic and Health Survey; T.R. Presidency of Turkey Directorate of Strategy and Budget and TÜBİTAK; Elma Teknik Basım Matbaacılık Ltd. Şti.: Ankara, Turkey, 2019; p. 282.

Tanacan A, Unal C, Yucesoy HM, Duru SA, Beksac MS (2019) Management and evaluation of pregnant women with Takayasu arteritis. Arch Gynecol Obstet 299:79–88. https://doi.org/10.1007/s00404-018-4927-x

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 285:377–378. https://doi.org/10.1007/s00404-011-1992-9

Tanaka H, Tanaka K, Kamiya C, Iwanaga N, Yoshimatsu J (2014) Analysis of pregnancies in women with Takayasu arteritis: complication of Takayasu arteritis involving obstetric or cardiovascular events. J Obstet Gynaecol Res 40:2031–2036. https://doi.org/10.1111/jog.12443

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