Pregnancy in Takayasu Arteritis Patients Exposed to Anti-Tumour Necrosis Factor (Anti-TNF)-α Therapy

Valentina Canti*, Elena Baldissera, Susanna Rosa, Giuseppe A. Ramirez, Isadora Vaglio Tessitore, Maria Grazia Sabbadini, Maria Teresa Castiglioni and Patrizia Rovere-Querini

Pregnancy in Takayasu Arteritis Patients Exposed to Anti-Tumour Necrosis Factor (Anti-TNF)-α Therapy

First patient, a 35 year old woman with a diagnosis of ulcerative colitis since childhood,
was diagnosed with TA in 2009. She had an uncomplicated pregnancy in 2004.

When she planned a second pregnancy, she was receiving IFX7 mg/ kg every-six-weeks plus chronic therapy.
At conception she had type-V-disease based on angiography.

Magnetic Resonance Angiography revealed thickening of the common carotid
arteries, aortic-arch, sovraortic branches and a 30-40% stenosis of the celiac tripod.

Positron Emission Tomography scan revealed increase vascular uptake in
the thoracic aorta and the aortic-arch.

Azathioprine was discontinued in the first 12 weeks gestation and IFX was
discontinued at 28 wg, respectively. Aspirin was administered
100 mg daily until 35 wg. Echocardiography at 12 and 28 wg
was normal and carotid ultrasonography at 24 wg was stable.

Fetal growth, umbilical and placental flow was repeatedly normal at
ultrasonography examination. Arterial blood pressure
was consistent and well-controlled.

At 37.5 wg she delivered a healthy child. IFX was started four weeks postpartum.
MRA two months after delivery revealed significantly reduced thickening
of involved arteries.

TA Damage Score, a clinical score of TA damage, remained unchanged.
Anti-TNF agents, IFX in particular,1 appear safe and effective in rheumatic patients during pregnancy.

Here, we described two successful pregnancies of TA patients treated with
IFX before conception and until 28 wg. Blood pressure remained optimal and the vascular inflammation/remodelling did not worsen.

The risk of infections is low. In our reported cases infections were not observed
in postpartum period till one years follow-up of the babies.

Gynecol Obstet Res Open J. 2015; 2(5): 96- 98. doi: 10.17140/GOROJ-2-122