• Christian Pagnoux, Véronique Le Guern, François Goffinet, Elisabeth Diot, Nicolas Limal, Emmanuelle Pannier, Ursula Warzocha, Vassilis Tsatsaris, Robin Dhote, Alexandre Karras, Pascal Cohen, Richard Damade, Luc Mouthon, and Loïc Guillevin.
• 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
• Rheumatology (Oxford). 2011 May 1;50(5):953-61.

ObjectivesTo 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.MethodsRetrospective analysis of women whose SNV appeared during pregnancy or who became pregnant after SNV diagnosis.ResultsAmong 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.ConclusionPregnant 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.

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