Is ANCA Vasculitis Incompatible With Pregnancy?

Pregnancy not only significantly heightens the risks of mortality due to of renal impairment and pulmonary hemorrhage among women with ANCA-associated vasculitis (AAV)—it may even be a trigger for AAV, according to research.

Authors of a review of pregnancy and AAV published in the Archives of Gynecology and Obstetrics, “there are several cases which describe the first presentation of AAV during pregnancy, with severe disease courses.”

Still, the authors state, AAV that is “truly controlled at the time of conception” is not an absolute contraindication for pregnancy. They advise that patients should achieve stable remission for 6 months with a medication that can be continued throughout pregnancy. The treating rheumatologist should adjust medication prior to conception, and patients with AAV should be closely monitored during pregnancy by not only the rheumatologist but also by maternal-fetal health specialists.

“In cases of uncontrolled disease flare, the potentially fatal risks of the disease have to be respected and necessity of induction therapies with GC [glucocorticoids] + CYC [cyclophosphamide] or RTX [rituximab] has to be discussed individually,” they caution.

“Patients with diagnosed AAV planning to become pregnant should be counselled by their rheumatologist and gynecologist with experiences in high-risk pregnancies,” they advise.

—Rebecca Mashaw

Reference:

Pecher AC, Henes M, Henes JC. Optimal management of ANCA-associated vasculitis before and during pregnancy: current perspectives. Arch Gynecol Obstet. Published online September 14, 2022. https://doi.org/10.1007/s00404-022-06744-5