title: Maternal, pregnancy and fetal outcomes in de novo anti-glomerular basement membrane antibody disease in pregnancy: a systematic review.
abstract: BACKGROUND
  Outside of pregnancy, anti-glomerular basement membrane (GBM) antibody disease is associated with significant morbidity and mortality. However, there is limited knowledge regarding de novo anti-GBM disease in pregnancy.
  
  
  METHODS
  A systematic review was performed to identify maternal, pregnancy and fetal outcomes in de novo anti-GBM disease in pregnancy. Studies were selected from PubMed, EMBASE, Cochrane Library databases and conference proceedings, without language restriction.
  
  
  RESULTS
  Data from eight patients were derived from seven case reports and one unpublished case. Most (6/8) patients presented after the first trimester. During pregnancy, acute kidney injury (5/8), anemia (5/8), hematuria (8/8) and proteinuria (8/8) were common. When hemodialysis was required antepartum (5/8), renal function recovery to independence of renal replacement was unlikely (2/5). While pulmonary involvement was common (5/8), no permanent damage was reported (0/8). The majority of cases ended in live births (6/8) although prematurity (6/6), intrauterine growth restriction (2/6), small for gestational age (4/6) and complications of prematurity (1/6) were common. When anti-GBM levels were tested in the living newborn, they were detectable (2/5), but no newborn renal or lung disease was reported (0/6). Complications in pregnancy included gestational diabetes (3/8), hyperemesis gravidarum (2/8) and preeclampsia (2/8).
  
  
  CONCLUSIONS
  Live births can be achieved in de novo anti-GBM disease in pregnancy, but are commonly associated with adverse maternal, pregnancy and fetal outcomes. Only with awareness of common presentations, and management strategies can outcomes be optimized.
authors: Division of Nephrology, Department of Medicine , London Health Sciences Centre and Western University , London, ON , Canada.
authors: Benjamin
authors: B
authors: Thomson
authors: Division of Nephrology, Department of Medicine , McMaster University , Hamilton, ON , Canada.
authors: Geena
authors: G
authors: Joseph
authors: Division of Nephrology, Department of Medicine , London Health Sciences Centre and Western University , London, ON , Canada ; Kidney Clinical Research Unit , Schulich School of Medicine and Dentistry, Western University , London, ON , Canada.
authors: William F
authors: WF
authors: Clark
authors: Division of Nephrology, Department of Medicine , University of Toronto , Toronto, ON , Canada.
authors: Michelle
authors: M
authors: Hladunewich
authors: Division of Nephrology, Department of Medicine , London Health Sciences Centre and Western University , London, ON , Canada.
authors: Amit
authors: A
authors: Patel
authors: Division of Nephrology, Department of Medicine , London Health Sciences Centre and Western University , London, ON , Canada.
authors: Peter
authors: P
authors: Blake
authors: Department of Obstetrics and Gynaecoology , London Health Sciences Centre and Western University , London, ON , Canada.
authors: Genevieve
authors: G
authors: Eastabrook
authors: Department of Paediatrics , Western University , London, ON , Canada.
authors: Doreen
authors: D
authors: Matsui
authors: Department of Paediatrics , Western University , London, ON , Canada.
authors: Ajay
authors: A
authors: Sharma
authors: Division of Nephrology, Department of Medicine , London Health Sciences Centre and Western University , London, ON , Canada.
authors: Andrew
authors: A
authors: House
keywords: Goodpasture's disease; anti-GBM; placenta; pregnancy; vasculitis