Takayasu Arteritis and Pregnancy

Introduction

Takayasu arteritis, a rare autoimmune disease affecting the aorta and its branches, poses unique challenges during pregnancy. This condition, characterized by vessel inflammation, can lead to complications such as hypertension and decreased blood flow to vital organs. Management requires close monitoring to mitigate risks to both mother and fetus, often involving a multidisciplinary approach combining rheumatology, obstetrics, and cardiology expertise.

What Is Takayasu Arteritis?

Takayasu arteritis (TA) is a rare autoimmune disease characterized by inflammation of the large arteries, particularly the aorta and its main branches. This chronic inflammatory condition leads to narrowing, blockage, or weakening of the affected arteries, resulting in reduced blood flow to various organs and tissues throughout the body. Takayasu arteritis predominantly affects young to middle-aged women, although it can occur in people of any age or gender. The precise origin of Takayasu arteritis remains uncertain; however, it is thought to result from an aberrant immune reaction, potentially influenced by genetic predisposition or environmental factors. The diagnostic process usually combines reviewing medical history, conducting a physical examination, utilizing imaging techniques like angiography, and performing blood tests to evaluate inflammation levels. Treatment aims to control inflammation, manage symptoms, and prevent complications through medications, lifestyle modifications, and, occasionally, surgical interventions.

What Are the Symptoms of Takayasu Arteritis?

Takayasu arteritis (TA) manifests through various symptoms, which can vary widely among individuals and depend on the extent and location of arterial involvement. Common symptoms of Takayasu arteritis include:

• Fatigue: Persistent tiredness and lack of energy are common complaints among individuals with TA, often impacting daily activities.

• Muscle Pain: Pain or tenderness in the muscles, particularly those of the arms, shoulders, neck, and thighs, may occur due to reduced blood flow and inflammation.

• Fever: Low-grade fever may be present, reflecting the systemic inflammatory nature of the disease.

• Unintentional Weight Loss: Some individuals with TA may experience unexplained weight loss due to inflammation and metabolic changes associated with the disease.

• Dizziness and Fainting: Reduced blood flow to the brain can lead to symptoms such as dizziness, lightheadedness, and fainting spells.

• Headaches: Persistent headaches, often described as throbbing or pulsating, may occur due to inflammation of the arteries supplying the head and neck.

• Reduced Pulse: Weak or absent pulses in the arms or legs may be noticed upon physical examination, reflecting arterial narrowing or blockage.

• Vision Changes: Blurred vision, double vision (diplopia), or visual loss may occur if the arteries supplying the eyes are affected.

• High Blood Pressure: Hypertension (high blood pressure) is a common complication of TA, occurring due to the narrowing of the arteries and increased resistance to blood flow.

• Chest Pain: Individuals with Takayasu arteritis (TA) may experience chest pain resembling angina, especially during physical activity, resulting from decreased blood flow to the heart muscle.

What Are the Challenges in Takayasu Arteritis and Pregnancy?

Pregnancy presents numerous challenges for women with Takayasu arteritis (TA) due to the intricate relationship between maternal disease activity, cardiovascular issues, and the welfare of the fetus. Here are some of the key challenges:

• Maternal Cardiovascular Risks: Women diagnosed with Takayasu arteritis (TA) face heightened susceptibility to cardiovascular issues, including hypertension, aortic regurgitation, coronary artery engagement, and renal artery stenosis. Pregnancy-related hemodynamic changes, including increased blood volume and cardiac output, can exacerbate these cardiovascular risks. Managing blood pressure and preventing complications such as heart failure, arrhythmias, and aortic dissection becomes crucial during pregnancy.

• Maternal Disease Activity: Pregnancy can influence the course of TA, with some women experiencing disease exacerbation, while others may achieve remission. Fluctuations in disease activity can lead to unpredictable symptoms such as fatigue, arthralgia, myalgia, and constitutional symptoms like fever and weight loss. Close monitoring of disease activity through clinical assessments, inflammatory markers, and imaging studies is essential to adjust treatment regimens accordingly and minimize maternal complications.

• Medication Management: Balancing maternal disease control with fetal safety presents a significant challenge in managing TA during pregnancy. Many medications commonly used to treat TA, such as corticosteroids, immunosuppressants, and biologic agents, have potential risks to the developing fetus. Rheumatologists and obstetricians must carefully weigh the benefits and risks of medication use, considering the potential impact on maternal disease activity and fetal health. In some cases, medications may need to be adjusted or discontinued, with close monitoring of disease activity and maternal well-being.

• Increased Risk of Pregnancy Complications: Women with TA are at higher risk of developing pregnancy complications such as preeclampsia, gestational hypertension, and intrauterine growth restriction (IUGR). The vascular irregularities and cardiovascular implications inherent in Takayasu arteritis (TA) can increase the likelihood of these complications in pregnant women, potentially impacting both maternal and fetal health outcomes. Close monitoring of blood pressure, fetal growth, and placental function is essential to detect and manage these complications promptly.

• Fetal Growth Restriction (FGR): The compromised blood flow resulting from arterial stenosis or occlusion in TA can lead to inadequate placental perfusion, increasing the risk of fetal growth restriction (FGR). FGR is associated with an increased risk of neonatal complications, including low birth weight, preterm birth, and perinatal mortality. Regular fetal surveillance through serial ultrasound examinations is crucial to detect signs of FGR early and intervene to optimize fetal outcomes.

• Preterm Birth Risk: Pregnancies complicated by TA are at heightened risk of preterm birth, defined as delivery before 37 weeks of gestation. The underlying vascular abnormalities, maternal comorbidities, and pregnancy complications associated with TA contribute to the increased likelihood of preterm labor and delivery. Preterm birth poses various risks to the newborn, including respiratory distress syndrome, immature organ development, and long-term neurodevelopmental complications.

• Postpartum Disease Flare: The postpartum period is a critical time for women with TA, as disease activity may fluctuate following delivery. The abrupt hormonal and hemodynamic changes that occur after childbirth can trigger disease flares or exacerbations. Close monitoring of maternal symptoms, blood pressure, and inflammatory markers is essential to detect and manage any disease flares or complications promptly.

• Delivery Planning and Management: Delivery planning in women with TA requires careful consideration of maternal disease activity, cardiovascular status, and fetal well-being. Obstetricians and rheumatologists collaborate to determine the optimal mode and timing of delivery based on these factors. In cases of stable maternal disease, vaginal delivery may be feasible, while cesarean delivery may be indicated in the presence of significant cardiovascular involvement or concerns regarding fetal distress.

Conclusion

Managing Takayasu arteritis during pregnancy requires careful coordination and monitoring to mitigate maternal cardiovascular risks, medication management challenges, and potential adverse fetal outcomes, ensuring optimal outcomes for both mother and baby. Diagnosis and management of Takayasu arteritis in pregnancy are essential. Reaching out to the healthcare specialist and getting appropriate treatment may be beneficial.