Successful delivery in pregnancy complicated by multiple Takayasu arteritis: a case report and clinical experience

Takayasu arteritis (TA) is a rare immune system disorder that predominantly affects young women, potentially involving large arteries throughout the body and leading to organ dysfunction. For TA patients, pregnancy eligibility and optimal timing require comprehensive assessment of disease severity. Management during pregnancy extends beyond timely pharmacologic control to necessitate immediate multidisciplinary response capabilities for unpredictable complications. We describe the successful delivery in a pregnant patient with active TA. The uniqueness of this case lies in the presence of severe complications (to the extent that pregnancy was contraindicated) alongside the patient's strong desire to continue the pregnancy, ultimately resulting in successful delivery through multidisciplinary collaboration.

A 26-year-old primigravida (G1P0) was diagnosed with TA at West China Hospital in 2018 due to dizziness and headache (treated with oral medication including oral prednisone and calcitriol; poor compliance with specific regimen unknown). In 2023, her condition worsened, complicated by spontaneous syncope, leading to treatment at Peking Hospital and Peking Union Medical College Hospital. She underwent bilateral carotid artery replacement surgery and received prednisone and clopidogrel. During this pregnancy, ultrasound and computed tomography scans at Peking Union Medical College Hospital at 7 and 11 weeks' gestation revealed vascular stenosis and cardiac dysfunction secondary to TA. Given the high-risk pregnancy, multidisciplinary consultations at multiple institutions (including Peking Union Medical College Hospital and Beijing Obstetrics & Gynecology Hospital) recommended termination. The patient and her family, however, opted to continue the pregnancy. In September 2024, she presented to West China Second University Hospital. Through coordinated multidisciplinary team management-including medical therapy (tacrolimus 2 mg orally every morning and 1 mg every evening, combined with prednisone 10 mg orally daily), disease monitoring, fetal growth assessments, and priority admission pathways-she successfully delivered a healthy infant via cesarean section at 34 weeks' gestation. At the 42-day postpartum follow-up, her condition remained stable.

Pregnancy complicated by uncontrolled TA poses significant risks to maternal and fetal health, necessitating thorough risk stratification and individualized management strategies. Beyond pharmacologic control during gestation, establishing a readily available multidisciplinary team with emergency management capabilities is imperative.