Vasculitis during pregnancy increases risks for spontaneous abortion, preterm delivery
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SAN DIEGO — Pregnant patients with vasculitis demonstrate an increased frequency of spontaneous abortion and preterm delivery vs. healthy controls, according to data presented at ACR Convergence 2023.
“Last year at ACR, we presented data from a California birth registry on the increased risk for preterm delivery and hypertensive disorders of pregnancy in patients with vasculitis,” Audra Horomanski, MD, director of the Stanford Vasculitis Clinic and associate program director of rheumatology fellowship at Stanford University, told Healio. “However, we were only able to capture 96 deliveries due to the rarity of these diseases and events. We wanted to expand this work to a nationwide database to both confirm these findings and discern if there are differences in risks between vasculitis subtypes.”
She added that there is currently insufficient research on preterm delivery and maternal complications in systemic vasculitides.
To assessed pregnancy outcomes in patients with vasculitis, Horomanski and colleagues analyzed administrative claims data from private health insurance providers. The researchers identified 665 pregnancies among 527 patients with vasculitis as well as 4,209,034 pregnancies among 2,932,379 individuals from the general population. All included pregnancies had been reported between 2007 and 2021.
Patients in the vasculitis group were defined by ICD coded outpatient or inpatient visits and categorized as either small, medium or large-vessel disease. The reference population included individuals with no ICD code for any other rheumatic disease.
According to the researchers, spontaneous abortion was more frequent in the vasculitis group, as were elective termination, ectopic and molar pregnancies. In addition, preterm deliveries were twice as frequent in the vasculitis group vs. the control population. Moreover, preeclampsia was 12% more common in the vasculitis group than in controls. Meanwhile, multiparous pregnancies were more likely to be preterm than nulliparous pregnancies, the researchers wrote. These pregnancies also were more likely to be complicated by gestational diabetes, pre-pregnancy hypertension, obesity and hypothyroidism.
Spontaneous abortion, preterm delivery and other comorbidities were more common among patients with small vessel vasculitis, compared to other vasculitis subtypes, the researchers added.
“Vasculitis patients had a higher risk for preterm delivery, particularly medically indicated preterm delivery, and preeclampsia/eclampsia,” Horomanski said. “Of the different vasculitis subgroups, small vessel vasculitis patients had the highest risk for these outcomes.
“Vasculitis patients do pursue pregnancy, particularly with recent advances in treatment and decreased toxicity,” she added. “The more we know about the associated the risks, the better providers can counsel patients to help them make reproductive decisions.”
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Horomanski A. Abstract 2425. Presented at: ACR Convergence 2023; Nov. 10-15, 2023; San Diego.
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