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Pregnancy and Takayasu arteritis: case-based review

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Abstract

Takayasu arteritis (TA) is a rare large vessel vasculitis that particularly affects women of child-bearing age. Management of pregnant patients with TA is often challenging due to the cardiovascular and cerebrovascular complications of the disease. We report two new cases of pregnancy in patients with TA and review all published cases from sub-Saharan Africa. Analysis of 16 pregnancies in 15 patients (including our two cases) showed that seven patients had radiographic Type V TA disease, namely involvement of the entire length of the aorta. Four patients were newly diagnosed with TA during pregnancy and two pregnancies were unbooked at time of first presentation. Seven pregnancies were complicated by disease flares (n = 4) and/or hypertension (n = 6). Four pregnancies resulted in preterm delivery and six required caesarean sections. There was one documented case of pre-eclampsia resulting in the only maternal death. Intrauterine growth restriction was documented in two of six pregnancies in which foetal ultrasonography was performed. There were four low birth weight infants and one fresh stillbirth (associated with the maternal death). In the handful of case reports of pregnancy in TA from sub-Saharan Africa, both maternal and foetal outcomes were generally good and similar to international findings. In a substantial proportion of patients, the diagnosis of TA was made in pregnancy, reflecting challenges of access to appropriate health care in resource constrained sub-Saharan Africa.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Nirvana Bharuthram & Mohammed Tikly

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  1. Nirvana Bharuthram
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  2. Mohammed Tikly
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In accordance with the ICMJE criteria, both authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Nirvana Bharuthram.

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Ethical approval was not required for this case-based review as it contains retrospective data of patients and all management plans were made prior to our analysis.

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Bharuthram, N., Tikly, M. Pregnancy and Takayasu arteritis: case-based review. Rheumatol Int 40, 799–809 (2020). https://doi.org/10.1007/s00296-019-04499-y

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