Careful planning and counseling prior to conception provide best potential for a safe outcome
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
A 34-year-old female you have followed for granulomatosis with polyangiitis (GPA) comes to your clinic to discuss whether she is able to pursue a pregnancy. She was diagnosed with GPA at age 30 and presented with features that included sinus disease, pulmonary nodules, arthralgias, glomerulonephritis with a peak creatinine of 3.0 mg/dL, and a positive PR3-cANCA. For this she was treated with prednisone and rituximab on which her creatinine improved to a baseline of 1.7 mg/dL. She has remained in remission since that time on her current medications of azathioprine 150 mg daily, lisinopril 20 mg daily, and an oral contraceptive. What are the key discussion points you need to have with your patient?
With the evolution of management options, pregnancy has become a feasible and realistic goal for many women with vasculitis. Most forms of vasculitis can impact women capable of having a child but prominently include Takayasu arteritis and ANCA-associated vasculitis.1-3 The published literature on pregnancies in vasculitis remains small and often encompasses all of these diseases, although there are some unique differences.3
For young women with vasculitis, it is important to begin the discussion about the potential for pregnancy early in their disease course. This is not only related to the teratogenicity of some medications but also because careful planning and counseling prior to pursuing conception provides a woman and her child with the greatest potential for a safe outcome. When a woman begins to plan for a future pregnancy there are several key issues that should be discussed:
Each of these issues was carefully discussed with the patient. As she was in a stable remission, it was an appropriate time for her to consider a pregnancy. The main feature of concern was her renal insufficiency for which she was seen prior to conception by nephrology. In addition to discussion about the potential impact of pregnancy on her kidney function, the lisinopril was stopped — as this cannot be taken during pregnancy — and replaced by labetalol with home blood pressure monitoring. She was also seen by high-risk obstetrics. After counseling, the patient chose to pursue conception and remain on azathioprine during her pregnancy.
As more women with vasculitis are choosing to pursue pregnancies, it is critical for us to gain a greater understanding of their experiences. The Vasculitis Pregnancy Registry (V-PREG) that is being conducted through the Vasculitis Patient-Powered Research Network is an important initiative that will provide valuable prospective information on how vasculitis impacts reproductive health and pregnancy outcomes. Further information on the registry and how your patients can participate can be found at (https://www.vpprn.org/vpreg).
Comparing strategies for cesarean prophylaxis with penicillin allergy
Counseling and careful surgical considerations are key
Deprivation is linked to impaired glucose intolerance and racial disparities
Perioperative prophylaxis and class III obesity
Artesunate ointment is safe well and tolerated patients with vulvar intraepithelial neoplasia
Endoscopic balloon dilation during pregnancy helps optimize outcomes
Researchers examine waste and implore colleagues to take action
Mode of delivery does not affect patient satisfaction