Pregnant Women With AAV at Risk for Adverse Outcomes and Increased Disease Flare

Pregnant women with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) may be at increased risk for adverse outcomes and disease flare, according to results from a recent study published in Joint Bone Spine.

Investigators assessed the prevalence of pregnancy complications and unfavorable outcomes among pregnant women with AAV.

A systematic review and meta-analysis were performed using PubMed, Scopus, Cochrane Library, and Cinahl databases from inception to September 2022. Pregnant women aged 18 years or older with AAV were included in the study.

Preterm delivery (defined as delivery before week 37 of gestation), infants born classified as intrauterine growth restriction (IUGR) neonates (defined as fetal weight below the 10^th percentile based on gestational age), and disease flare were the main study outcomes.

A total of 6 studies that included 92 pregnancies among patients with AAV were included in the analysis.

The prevalence of infants born as IUGR neonates was 20% (95% CI, 0.11-0.33), preterm delivery was 18% (95% CI, 0.10-0.30), and disease flare was 28% (95% CI, 0.09-0.59; P <.01). Preterm delivery and IUGR prevalence were not statistically significant.

This analysis was limited by the small number of included studies, which lowers the statistical power. Due to the small number of participants and incomplete vasculitis subclassification among certain studies, a subgroup analysis was not possible.

The study authors noted, “Despite the high rates of pre-term delivery, IUGR and disease flare, most pregnancies resulted in healthy newborns and manageable, non-life-threatening flares of AAV.”

“These findings indicate that pregnancy in this population can be successful, mainly when conception is achieved during remission. Due to the inflammatory nature of these vasculitides, close monitoring and increased awareness are of great importance,” they concluded.