PMID- 30288261
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240401
IS  - 2048-8505 (Print)
IS  - 2048-8513 (Electronic)
IS  - 2048-8505 (Linking)
VI  - 11
IP  - 5
DP  - 2018 Oct
TI  - De novo antineutrophil cytoplasmic antibody-associated vasculitis in pregnancy: a 
      systematic review on maternal, pregnancy and fetal outcomes.
PG  - 659-666
LID - 10.1093/ckj/sfy011 [doi]
AB  - BACKGROUND: De novo antineutrophil cytoplasmic antibody-associated vasculitis 
      typically arises in post-reproductive years, but can occur during pregnancy. 
      Concerns of treatment-related teratogenicity persist, while efficacy and safety 
      of new therapies including intravenous immunoglobulin (IVIG) and rituximab are 
      uncertain. There remains a paucity of maternal, fetal and pregnancy outcome data 
      in these women, and therefore a lack of guidance on safe treatment for 
      clinicians. METHODS: We conducted a systematic review of the literature and a 
      local, retrospective chart review of women with de novo antibody-associated 
      vasculitis (AAV) in pregnancy. Cochrane, Embase and PubMed databases and relevant 
      conference abstracts were searched. Patient demographics, clinical presentation, 
      management and outcomes (maternal, fetal and pregnancy-related) were analyzed. 
      RESULTS: Twenty-seven cases of de novo AAV in pregnancy were included. Women 
      presented were from 5 to 39 weeks' gestation, of which a majority were in the 
      second trimester (median 20 weeks). The median gravida of women was 2 and the 
      median parity was 1. Women were treated with steroids (89%), cyclophosphamide 
      (CYC) (37%), other immunosuppressive agents [azathioprine (AZA), IVIG, plasma 
      exchange (PLEX)] or no therapy (11%). High rates of serious complications, 
      including preeclampsia (29%) and maternal death (7%), were reported; however, 
      most pregnancies resulted in live birth (73%). Prematurity was common; 73% of 
      live births occurred prior to 37 weeks' gestation and 40% prior to 34 weeks' 
      gestation. The majority of infants were born in the third trimester (median 
      34.5 weeks). Rates of pregnancy termination were high (23%) and only one 
      intrauterine death was reported, shortly after initiation of therapy (4%). 
      Congenital abnormalities were rare, with one infant having a solitary, pelvic 
      kidney (6%) after maternal treatment with steroids, CYC and PLEX. Use of PLEX, 
      IVIG and AZA increased after 2005, whereas CYC use decreased. Remission often 
      occurred postpartum (60%). CONCLUSIONS: De novo AAV in pregnancy can result in 
      uncomplicated pregnancies; however, serious maternal risks exist. Further data on 
      potentially pregnancy compatible therapies such as IVIG and rituximab are needed 
      in this population.
FAU - Veltri, Nicole L
AU  - Veltri NL
AD  - Division of Internal Medicine, Department of Medicine, Queen's University, 
      Kingston, ON, Canada.
FAU - Hladunewich, Michelle
AU  - Hladunewich M
AD  - Division of Nephrology, Department of Medicine, University of Toronto, Toronto, 
      ON, Canada.
FAU - Bhasin, Arrti
AU  - Bhasin A
AD  - Division of Nephrology, Department of Medicine, University of Toronto, Toronto, 
      ON, Canada.
FAU - Garland, Jocelyn
AU  - Garland J
AD  - Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, 
      Canada.
FAU - Thomson, Benjamin
AU  - Thomson B
AD  - Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, 
      Canada.
LA  - eng
PT  - Journal Article
DEP - 20180315
PL  - England
TA  - Clin Kidney J
JT  - Clinical kidney journal
JID - 101579321
PMC - PMC6165750
OTO - NOTNLM
OT  - ANCA
OT  - eosinophilic granulomatosis with polyangiitis
OT  - granulomatosis with polyangiitis
OT  - microscopic polyangiitis
OT  - pregnancy
EDAT- 2018/10/06 06:00
MHDA- 2018/10/06 06:01
PMCR- 2018/03/15
CRDT- 2018/10/06 06:00
PHST- 2017/10/23 00:00 [received]
PHST- 2018/01/23 00:00 [accepted]
PHST- 2018/10/06 06:00 [entrez]
PHST- 2018/10/06 06:00 [pubmed]
PHST- 2018/10/06 06:01 [medline]
PHST- 2018/03/15 00:00 [pmc-release]
AID - sfy011 [pii]
AID - 10.1093/ckj/sfy011 [doi]
PST - ppublish
SO  - Clin Kidney J. 2018 Oct;11(5):659-666. doi: 10.1093/ckj/sfy011. Epub 2018 Mar 15.