Takayasu’s Arteritis (TA) is a large vessel vasculitis predominantly affecting the aorta and its branches. TA is often associated with hypertension which can lead to increased adverse maternal and neonatal outcomes in pregnancy.
A 28-year-old Chinese woman (G1P0) was referred at 31+3 weeks’ gestation with hypertension, on a background of Takayasu Arteritis which initially had presented with lower limb claudication. She was not on any immunosuppression, and disease activity status was uncertain. Non-invasive blood pressure was 200/80mmHg in the right arm, and 140/80mmHg in the left. Protein: creatinine ratio was 16 mg/mmol, with renal and liver function normal. There were no signs or symptoms of pre-eclampsia and her baby was appropriately grown for gestation, suggesting well-established collaterals. MRI demonstrated: no forward flow in the left vertebral artery; chronic proximal left subclavian occlusion and subclavian steal syndrome; marked progressive narrowing of the descending thoracic aorta; and proximal left renal artery stenosis. She was taken to ICU for persistent hypertension and received labetalol, nifedipine and IV hydralazine, as well as magnesium sulfate. She progressed to pre-eclampsia with haemolysis and thrombocytopaenia ; though renal and liver function remained normal. A baby boy weighing 1850g was delivered at 31+6 weeks’ gestation, with no major obstetric or neonatal complications. Haemoglobin and platelets both normalised by discharge. Post-partum, lower limb claudication was noted after fifteen minutes with peak CRP 64 and ESR 66 (8 and 11 at admission respectively). After commencement of azathioprine and prednisolone, claudication time improved to 50 minutes, with CRP settling to 7.7 and ESR 12. There have been no other systemic features of TA such as fevers or arthralgias throughout. Blood pressure is now controlled on irbesartan, chlorthalidone and metoprolol.
Although TA is associated with complications in pregnancy, it is possible to achieve positive obstetric outcomes. Early identification, close ante-natal checks and strict follow-up may avoid or minimise unnecessary complications. Optimisation of disease activity pre-pregnancy is likely beneficial.