Original article Pregnancy outcomes in women with a history of immunoglobulin A vasculitis Johannes Nossent 1,2 , Warren Raymond 2 , Helen Keen 2,3 , Charles Inderjeeth 1,2 and David Preen 4 Abstract Objectives. Case series suggest an increased risk of pregnancy complications in women with a history of IgA vasculitis (IgAV); however, no large quantitative studies have examined this possible association to date. We compared pregnancy rates and outcomes between female IgAV patients and controls and assessed flare risk of IgAV during pregnancy. Methods. Using state-wide hospital morbidity data we compared rates for live birth, preterm birth, abortive outcome and gestational complications between female IgAV patients (International Classification of Diseases-9-Clinical Modification 287.0; International Classification of Diseases-10-Australian Modification D69.0) (n = 121) and non-exposed age-matched controls (n = 284) in Western Australia. Results presented are means compared by KruskalWallis test and proportions with odds ratios (ORs) (95% CI) compared by  2 testing. Results. There were 247 pregnancies in IgAV patients during which no disease flares were recorded and 556 preg- nancies in controls. IgAV patients were younger at first pregnancy (24.7 vs 27.0 years, P < 0.01) and had 43 unsuccessful pregnancies (17.4%) and 204 live births with 17 preterm deliveries (8.3%). Women with IgAV had increased odds of spontaneous abortion (OR 1.9, 95% CI 1.1, 3.1, P = 0.04), preterm delivery (OR 2.0, 95% CI 1.1, 3.9, P = 0.02) and gestational hypertension (OR 4.7, 95% CI 2.3, 9.8). While gravidity did not differ (mean pregnancy number 2.4 vs 2.3, P = 0.36), IgAV patients had over a two-fold greater number of obstetric visits than controls (5.1 vs 2.5, P < 0.01). Conclusions. Hospitalization for IgAV has little impact on fertility and IgAV rarely flares during pregnancy. However, a history of IgAV associates with increased odds of spontaneous abortions, gestational hypertension and preterm delivery. Key words: IgA vasculitis, pregnancy, spontaneous abortion, caesarean, gestational hypertension Rheumatology key messages . Female patients with a history of IgA vasculitis are at increased risk of poor pregnancy outcomes. . As IgA vasculitis rarely flares during pregnancy, this suggests a late effect of IgA vasculitis. Introduction IgA vasculitis (IgAV) is the most frequent form of systemic vasculitis in childhood [1, 2]. While the characteristic lower extremity purpura in IgAV usually do not require specific treatment, complications such as arthritis, glomerulo- nephritis, haemorrhagic enteritis or central nervous system manifestations occur in 2550% of patients and may require treatment with corticosteroids and/or immunosuppressive drugs to prevent organ damage [3, 4]. Disease extent and severity as well as pharmacother- apy can impact on fertility and pregnancy outcomes in other types of systemic vasculitis, where pregnancy can also trigger disease flares [5, 6]. For IgAV patients there are few data regarding subsequent obstetric outcomes and flare risk, but it has been recommended that females with a history of IgAV should be closely monitored in preg- nancy [710]. However, population-based quantitative studies examining obstetric outcomes for these women are lacking. We compared pregnancy outcomes between IgAV patients and non-exposed controls in Western Australia (WA) from 1980 to 2015 and determined the effect of pregnancy on IgAV. Methods Data were sourced from the Hospital Morbidity Collection (HMC) and Emergency Department Data Collection, which 1 Department of Rheumatology, Sir Charles Gairdner Hospital, 2 Rheumatology Section, School of Medicine, University of Western Australia, 3 Department of Rheumatology, Fiona Stanley Hospital and 4 School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia Correspondence to: Johannes Nossent, Rheumatology Section, School of Medicine, University of Western Australia, 35 Stirling Highway, M503 Perth, Western Australia, Australia. E-mail: johannes.nossent@uwa.edu.au Submitted 16 July 2018; accepted 17 November 2018 ! The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com RHEUMATOLOGY Rheumatology 2019;58:884888 doi:10.1093/rheumatology/key408 Advance Access publication 24 December 2018 CLINICAL SCIENCE Downloaded from https://academic.oup.com/rheumatology/article/58/5/884/5258987 by guest on 02 September 2022