Rare vasculitis types and obstetric and neonatal outcomes - A population-based study

Vasculitis is an infrequent pathology among reproductive-aged women. While data exists regarding pregnancy outcomes in the more common vasculitis subtypes, data is limited regarding these outcomes in rare vasculitis subtypes. We aimed to compare pregnancy and perinatal outcomes between women who suffered from rare types of vasculitis and those who did not.

This was a retrospective cohort study using the Healthcare Cost and Utilization Project- Nationwide Inpatient Sample (HCUP-NIS). All pregnant women who delivered or had a maternal death in the US (2004-2014) with an ICD-9 diagnosis of any of the following rare vasculitis subtypes: Polyarteritis nodosa, acute febrile mucocutaneous lymph node syndrome, hypersensitivity angiitis, Wegner's granulomatosis, giant cell arteritis, and Takayasu arteritis were included in the study. We divided the cohort into women with rare vasculitides (study group) and women without (control group). The obstetric and perinatal outcomes of the two groups were compared using multivariate logistic regression, adjusting for potential confounders.

A total of 9 096 788 women met the inclusion criteria. Among them, 335 women (3.7/100000) had a diagnosis of rare vasculitis. Women with rare vasculitis, compared to those without, were more likely to be older; Caucasian; in the highest income quartile; be insured by private insurance; and have a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) ≥30, pregestational diabetes mellitus, thyroid disorders, and chronic hypertension (P < 0.05, all). Patients in the rare vasculitis group, compared to those without, had a higher rate of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI]: 1.4-2.56, P < 0.001); preterm delivery (aOR 1.76, 95% CI: 1.28-2.42, P < 0.001); and blood products transfusion (aOR 3.68, 95% CI: 2.14-6.34, P < 0.001); with higher rates of cesarean delivery (CD) (aOR 1.31, 95% CI: 1.05-1.64, P = 0.018); and a higher rate of congenital anomalies (aOR 4.1, 95% CI: 2.03-8.31, P < 0.001). Other perinatal outcomes, including placental abruption, hysterectomy, and venous thromboembolism, were comparable between the two groups.

Women with rare vasculitis had a higher incidence of maternal complications, including hypertensive disorders of pregnancy, cesarean delivery and preterm delivery, as well as an increased risk of congenital anomalies.