Maternal and perinatal outcomes in vasculitis: a 15-year study at a Portuguese tertiary multidisciplinary centre

To evaluate maternal and perinatal outcomes in women with vasculitis and identify risk factors for adverse pregnancy outcomes (APOs).

This retrospective study included pregnant women with systemic vasculitis followed between 2009 and 2024 at a multidisciplinary tertiary centre. Clinical data on patient characteristics, disease activity (remission or relapse), treatment and pregnancy outcomes were collected. APOs comprised miscarriage, stillbirth, preterm birth, foetal growth restriction (FGR), small for gestational age (SGA) and pre-eclampsia. Associations between clinical variables and APOs were assessed using univariate analysis and multivariate binary logistic regression.

A total of 39 pregnancies occurred in 28 women with vasculitis. Most pregnancies (92.3%) occurred during clinical remission. The most frequent vasculitis subtypes were Behçet's disease (n = 22), polyarteritis nodosa (n = 5) and Takayasu arteritis (n = 5). Only 17.9% of pregnancies were preceded by formal preconception counselling. Disease relapses were observed in 14 pregnancies (35.9%) and 5 postpartum periods (12.8%). APOs were reported in 13 pregnancies (33.3%), including 3 miscarriages (7.7%), 6 preterm births (15.4%), 6 SGA (15.4%), 2 FGR (5.1%) and 1 pre-eclampsia (2.6%). Prednisolone use and relapses during pregnancy were independently associated with APOs [odds ratio (OR) 26.10, P = 0.024; OR 8.90, P = 0.019). No associations were found for maternal age, cumulative prednisone dose or use of immunosuppressants. No maternal deaths or severe neonatal complications occurred.

Pregnancy in women with vasculitis is often successful in the context of clinical remission at conception. Our findings are exploratory but suggest that prednisolone use and disease relapse may increase the risk of APOs, highlighting the importance of preconception counselling and multidisciplinary care throughout pregnancy.