Pregnancy in Systemic Vasculitis

Abstract

Conception, pregnancy and childbirth are a biological necessity, a unique privilege and birthright and yet something that mothers suffering with vasculitis cannot take for granted. Takayasu arteritis and Behcet’s disease mainly, but also ANCA associated vasculitis and IgA vasculitis are of relevance in this population. A diagnosis of systemic vasculitis has meant a lower chance of stable relationships, lower fertility, lower conception rates and worse foetal outcomes. Systemic vasculitis or it’s treatment may affect fertility by direct involvement of the reproductive organs, teratogenicity, induced infertility, or by producing a state inducing an inability of the maternal body to carry a foetus to term. Unfortunately, there is sometimes the need for medical termination. Pregnancy outcomes are poorer in women with a diagnosis of vasculitis, but this may be truer for women with Takayasu arteritis than Behcet’s disease. In spite of the many challenges in looking after expectant mothers with systemic vasculitis, we suggest some basic principles in this chapter to improve maternal and foetal outcomes. This is largely an evidence-free zone and this stream of medicine involving motherhood, babies and life-threatening rare diseases will remain emotive and therefore difficult, calling for the best that clinicians can offer.