Audra Horomanski1, Gary Shaw2, Jonathan Mayo3 and Julia Simard4, 1Stanford University, Stanford, CA, 2Stanford University School of Medicine, Palo Alto, 3Stanford University, Stanford, 4Stanford University School of Medicine, Palo Alto, CA
Background/Purpose: Systemic vasculitides are rare disorders characterized by vascular inflammation that can affect virtually every organ system. Recent treatment advances have increased life expectancy and reduced reproductive toxicity, allowing more patients the opportunity to pursue pregnancy. Little is known about maternal and fetal risks associated with pregnancy and delivery in these patients, although small studies suggest a higher risk of hypertensive disorders of pregnancy. Given the rarity of systemic vasculitides, analysis of large datasets offers the greatest opportunity for drawing meaningful conclusions.
Methods: Deliveries to nulliparous patients with prevalent systemic vasculitides (Takayasu's Arteritis (TAK), Behçet's Disease (BD), ANCA-Associated Vasculitis (AAV), and Kawasaki Disease (KD)) were identified using ICD-9 codes in maternally linked data and birth records from the California Office of State Health Planning and Development (OSHPD) and California Vital Statistics from 1991 to 2012. Maternal hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, and preterm delivery (PTD) phenotypes of all PTD (20-36 weeks), preterm premature rupture of membranes (PPROM) and spontaneous PTD were identified. Multivariable Poisson regression models estimated risk ratios (RRs) of these outcomes compared to the general obstetric population without history of rheumatic disease. Models were adjusted for maternal age, race/ethnicity, education level, prenatal care, payer, and delivery year.
Results: 87 first deliveries to patients with systemic vasculitis were identified (TAK: 14; AAV: 31; BD: 26; KD: 6) and compared to 4,191,909 deliveries of the general population. Adjusted RR for all PTD was elevated in vasculitis patients (RR 3.22, 95% CI 2.12, 4.89) as were the RRs of all PTD phenotypes including PPROM (RR 3.96, 95% CI 1.78-8.81) and spontaneous PTD (RR 5.10, 95% CI 3.02, 8.62). Of the spontaneous PTDs, 16.7% were early preterm deliveries (20-31 weeks), with the remaining 83.3% occurring between 32-36 weeks. Vasculitis patients also had an elevated risk of hypertensive disorders of pregnancy (RR 2.99, 95% CI 1.70, 5.27).
Conclusion: Among first deliveries, we found that patients with systemic vasculitis have an elevated risk of preterm delivery phenotypes as well as maternal hypertensive disorders of pregnancy.
Disclosures: A. Horomanski, Chemocentryx; G. Shaw, None; J. Mayo, None; J. Simard, None.
.png "Audra Horomanski, MD, RhMSUS photo")
