VIDEO: Monitoring risks associated with pregnancy for patients vasculitis

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When talking about pregnancy and vasculitis, that's a really, really broad question, and mostly because when we say systemic vasculitis, this is actually a collection of many different disorders, all of which carry very different risks.

For example, with some of the recent studies from our group as well as some other vasculitis study groups, we're seeing that certain types of vasculitis, for example, small vessel vasculitis, ANCA-associated vasculitis may carry higher risks compared to some of our other types of vasculitis, such as Behcet's disease, for example. We know that especially small vessel vasculitis, lots of good data in Takayasu arteritis too, suggesting that there’s an increased risk of preeclampsia and hypertensive disorders of pregnancy as well as preterm delivery in these patients, which can have longstanding impacts on both the patient and their children going forward.

And so the knowledge and the experience of clinicians and their patients going through this process of pregnancy and postpartum care is super, super important that we're discussing and monitoring for all of these different risks. My hope, again, is that we can move forward from knowing the risks and being able to counsel about the risks to actually being able to do something to help mitigate and reduce these risks.

Generally, when we talk about how we approach pregnancy in patients who have vasculitis, we want to ideally, in an ideal situation and ideal world, have a patient who has a very good control of their disease activity, so in near or clinical remission, and have them on pregnancy-compatible medications, and so medications that they can continue to help control their disease during pregnancy. There's always this question of, will my vasculitis get worse, or will it get better during pregnancy?

In some rheumatic diseases, we see people's disease activity improve during pregnancy, such as rheumatoid arthritis, for example. Kind of the classic example of a disease that generally becomes easier to control or quieter during the pregnancy of most, but not all patients. That does not so far seem to be the case with most of our types of vasculitis. We do have some small but good studies that have shown an increased risk of flare, especially serious flare, during pregnancy in a variety of different types of vasculitis. And so not only do we want people ideally in good disease control, on pregnancy-compatible medications, but also with very close multidisciplinary monitoring throughout their pregnancy, usually in conjunction with a rheumatologist and a maternal fetal medicine specialist or a high-risk obstetrics group as well, and that those patients should be assessed very regularly for all of these different pregnancy complications that we are outlining and discovering as we go forward.