VIDEO: Counsel patients with vasculitis about pregnancy risks early in disease course

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Morbidity and mortality are very high in ANCA vasculitis patients, especially when they're pregnant. And we have studies that show that some complications related to the disease in pregnancy are intrauterine growth restriction and preterm labor. So, in patients that have progressive kidney disease with worsening GFR, some other risks come up such as preeclampsia and hypertension.

Overall, it is very important when we have patients with known ANCA-associated vasculitis, that we counsel them about pregnancy risks early in their disease course to help them have an understanding of the risks, their immunosuppressant medications that we treat them with, such as Cytoxan, that are required for the disease but are teratogenic. And in knowing those risks and counseling them, we can work together to make sure that they're on contraception and also find a good time in their disease course for them to get pregnant safely.

Nephrologists are often consulted on these ANCA-associated vasculitis patients, either if they have a new diagnosis of the disease during their pregnancy or if they had known vasculitis that now is relapsing during their pregnancy. And that is found out when we see urine sediment showing proteinuria and hematuria as those are checked very regularly during pregnancy. And we can also find out the diagnosis through serologic workup with PR3 and MPO.

Management can be very tricky as biopsy is a risk during pregnancy and we wouldn’t have that information. And there are only certain treatments that we can use during pregnancy that are safe, such as steroid and azathioprine. So, we need to work together with the rheumatologists to find the best treatment during pregnancy.