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Abstract: SA-PO410

Pregnancy Outcomes in ANCA-Associated Vasculitis: A Retrospective Review

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Swee, Melissa L., University of Iowa, North Liberty, Iowa, United States
  • Strouse, Jennifer, University of Iowa, North Liberty, Iowa, United States
  • Gill, Mandeep S., University of Iowa, North Liberty, Iowa, United States
  • Suneja, Manish, The University of Iowa, Iowa City, Iowa, United States
  • Kumar, Bharat, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
Background

ANCA-Associated Vasculitis (AAV) is a small-vessel vasculitis that predominantly affects the kidneys and respiratory tract, among other organ systems. It has been traditionally associated with elderly males, but its occurrence in young, potentially childbearing, females is increasingly being recognized. In this study, we characterize the outcomes of pregnancy in ANCA-associated vasculitis.

Methods

We performed a retrospective chart review of all patients at the University of Iowa Hospitals and Clinics with a positive PR3 or MPO and a documented diagnosis of vasculitis between 2000 and 2017. Inclusion criteria included female sex and age younger than 45. Charts were reviewed to identify disease activity, clinical manifestations, medication regimens, and pregnancy outcomes.

Results

24 patients met the inclusion criteria, of which 11 were pregnant at some point, accounting for 29 total pregnancies. Among these, 8 had at least one pregnancy after the diagnosis of AAV and 5 before the diagnosis.

Those who were pregnant after diagnosis all had single pregnancies and accounted for 16 pregnancies in total. Seven pregnancies were viable, 2 are currently gravid, and 7 resulted in spontaneous abortions. Six (75%) were MPO positive while 2 (25%) were PR3 positive. Two patients were on moderate doses of prednisone (15mg – 20mg daily); the others were not on any immunosuppressive therapy. For induction therapy, 5 had cyclophosphamide, 1 had rituximab, and 2 had limited disease not requiring induction therapy. In vitro fertilization was documented in only 1 patient. Four were delivered by Caesarean section. All 6 who have completed pregnancy experienced complications, including premature birth (4), preeclampsia (2), preterm premature rupture of membranes (1), and cholestasis of pregnancy (1). One required tracheostomy for subglottic stenosis at 11 weeks.

Conclusion

Women with AAV should be considered at high risk for pregnancy complications due to the underlying disease and chronic immunosuppressive treatment regimens. With very close clinical monitoring, women with AAV may be able to conceive and give birth.