title: Successful outcome of pregnancy in patients with anti-neutrophil cytoplasm antibody-associated small vessel vasculitis.
abstract: Pregnancy in patients with anti-neutrophil cytoplasm antibody-associated vasculitis is reportedly associated with a high risk of fetal and maternal complications. Here we describe the outcome of pregnancies in patients with granulomatosis with polyangiitis and microscopic polyangiitis at five centers in the United Kingdom using a retrospective case review of all women who became pregnant following diagnosis. We report 15 pregnancies in 13 women resulting in 15 live births including one twin pregnancy and 13 singleton pregnancies. One patient had an unplanned pregnancy and a first trimester miscarriage while taking methotrexate. All other pregnancies were planned following a minimum of 6 months clinical remission. Eleven successful pregnancies were delivered vaginally at full term, whereas three were delivered by cesarean section. All infants were healthy with no neonatal complications on their initial health check within the first 24 h of delivery and no evidence of neonatal vasculitis. One relapse occurred during pregnancy and was successfully treated with an increased dose of azathioprine and corticosteroids, intravenous immunoglobulin, and plasma exchange therapy. One patient developed tracheal crusting and subglottic stenosis of infective etiology in the third trimester requiring tracheal debridement post delivery. No patient had a relapse in the first 12 months postpartum. Thus, successful pregnancy outcomes can occur following planned pregnancy in women in sustained remission on non-teratogenic therapies.
authors.affiliation: Department of Renal Immunobiology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Croft
authors.affiliation: Department of Renal Immunobiology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Smith
authors.affiliation: Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Carr
authors.affiliation: Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: Sajeda
authors.initials: S
authors.lastname: Youssouf
authors.affiliation: Centre for Nephrology, University College London, Royal Free Campus, London, UK.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Salama
authors.affiliation: Centre for Nephrology, University College London, Royal Free Campus, London, UK.
authors.forename: Aine
authors.initials: A
authors.lastname: Burns
authors.affiliation: Renal Section, Department of Medicine, Imperial College London, Hammersmith Campus, London, UK.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Pusey
authors.affiliation: Manchester Royal Infirmary, Manchester, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hamilton
authors.affiliation: Manchester Royal Infirmary, Manchester, UK.
authors.forename: Nina
authors.initials: N
authors.lastname: Brown
authors.affiliation: Manchester Royal Infirmary, Manchester, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Venning
authors.affiliation: Department of Renal Immunobiology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Harper
authors.affiliation: Department of Renal Immunobiology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Morgan
mesh_terms: D000022:Abortion, Spontaneous / Q000139:chemically induced; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D002585:Cesarean Section; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D050498:Live Birth; D008727:Methotrexate / Q000009:adverse effects; D055953:Microscopic Polyangiitis / Q000188:drug therapy* / Q000628:therapy; D010951:Plasma Exchange; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000628:therapy; D018566:Pregnancy, High-Risk; D049168:Pregnancy, Unplanned; D012008:Recurrence; D012189:Retrospective Studies; D047929:Term Birth; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D001379:Azathioprine; D008727:Methotrexate