title: Pregnancies in systemic necrotizing vasculitides: report on 12 women and their 20 pregnancies.
abstract: OBJECTIVE
  To describe pregnancies of women with systemic necrotizing vasculitides (SNVs), i.e. PAN, WG, Churg-Strauss syndrome (CSS) or microscopic polyangiitis (MPA), followed over the past 15 years at four French centres.
  
  
  METHODS
  Retrospective analysis of women whose SNV appeared during pregnancy or who became pregnant after SNV diagnosis.
  
  
  RESULTS
  Among the 12 women identified, one experienced rupture of pancreatic artery microaneurysms at 27 weeks revealing PAN, leading to surgical haemostasis and caesarean delivery. Eleven others started 19 pregnancies after SNV diagnosis (8 in four WG, 6 in three CSS, 1 each in three PAN and 2 in one MPA); 14 conceived during vasculitis remission. Two ended in first-trimester abortions, four miscarried; the remaining 13 pregnancies yielded 14 live newborns (1 twin pregnancy), with 7 pre-term births. Life-threatening complications occurred during 3 of these latter 13 pregnancies and required caesarean delivery. The twin pregnancy (in a CSS patient with initial vasculitis-related cardiac involvement, but in remission at conception) was complicated by transient maternal cardiac failure at 32 weeks. One WG patient with vasculitis-related renal damage developed thrombotic microangiopathy-associated renal impairment at 32 weeks, and another WG patient had severe pneumonia at 37 weeks. Other pregnancies were uneventful or with minor vasculitis manifestations.
  
  
  CONCLUSIONS
  Pregnant SNV patients should be monitored closely, because miscarriages and pre-term births are not uncommon. Pregnancy does not seem to have a major impact on vasculitis activity. However, life-threatening manifestations can occur, especially in patients with vasculitis-related cardiac or renal damage.
authors.affiliation: Department of Internal Medicine, National Referral Center for Necrotizing Vasculitides and Systemic Sclerosis, Université Paris Descartes, Hôpital Cochin, 27 rue du faubourg Saint-Jacques, 75679 Paris Cedex 14, France. christian.pagnoux@cch.aphp.fr
authors.forename: Christian
authors.initials: C
authors.lastname: Pagnoux
authors.forename: Véronique
authors.initials: V
authors.lastname: Le Guern
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Diot
authors.forename: Nicolas
authors.initials: N
authors.lastname: Limal
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Pannier
authors.forename: Ursula
authors.initials: U
authors.lastname: Warzocha
authors.forename: Vassilis
authors.initials: V
authors.lastname: Tsatsaris
authors.forename: Robin
authors.initials: R
authors.lastname: Dhote
authors.forename: Alexandre
authors.initials: A
authors.lastname: Karras
authors.forename: Pascal
authors.initials: P
authors.lastname: Cohen
authors.forename: Richard
authors.initials: R
authors.lastname: Damade
authors.forename: Luc
authors.initials: L
authors.lastname: Mouthon
authors.forename: Loïc
authors.initials: L
authors.lastname: Guillevin
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D015267:Churg-Strauss Syndrome / Q000150:complications / Q000175:diagnosis; D005260:Female; D005602:France; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000175:diagnosis; D006801:Humans; D055953:Microscopic Polyangiitis / Q000150:complications / Q000175:diagnosis; D010488:Polyarteritis Nodosa / Q000150:complications / Q000175:diagnosis; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000209:etiology*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D056647:Systemic Vasculitis / Q000150:complications* / Q000175:diagnosis*