How do pregnancy outcomes vary among different types of vasculitis?
• Antineutrophil cytoplasmic antibody-associated vasculitis: even if conception occurs with controlled disease, up to 40% of patients will flare during pregnancy. Disease activity during pregnancy is associated with preterm delivery and miscarriage as well as more serious outcomes.
• Polyarteritis nodosa (PAN): conception during remission results in good outcomes with rare flares. Onset of disease during pregnancy has a very high maternal mortality.
• Takayasu’s arteritis: pregnancies are more likely to be complicated by hypertension and preeclampsia (40% versus 8% in the general population). Pregnancy does not affect Takayasu’s arteritis in most cases, but complications may be devastating (e.g., aneurysmal rupture). Most adverse effects are not due to disease flares but due to vascular sequelae from previously active disease.
• Behçet’s disease: pregnancy outcomes are similar to general population. Up to 30% have disease relapse during pregnancy. Patients with prior thrombosis should be considered for intrapartum anticoagulation.