Highlights
- •About 40% of women with systemic vasculitis were treated by immunosuppressive drugs during pregnancy.
- •The number of patients treated with non-recommended immunosuppressant during pregnancy gradually decreased before pregnancy.
- •Proportion of systemic vasculitis flare did not increase significantly during pregnancy.
Abstract
Objective
Systemic vasculitis (SV) rarely affects women of childbearing age and only small series
have been reported to date in pregnant patients. The discovery of an unplanned pregnancy
can be an urgent cause for modifying treatments. This study aimed to describe immunosuppressive
drugs use before, during and after pregnancy in women with SV.
Methods
We conducted a cohort study using the French nationwide claims database. We included
all women with SV being pregnant between 2013 and 2018. Exposure of interest was defined
as exposure to oral systemic or injectable immunosuppressive drug identified using
out-hospital reimbursement data and in-hospital reimbursement for expensive drugs.
Results
Of 3,246,454 pregnancies, 649 pregnancies were observed in 606 women with SV. Immunosuppressant
and glucocorticoids use decreased before pregnancy and then increased after pregnancy
(48.4%, 40.7%, 50.4%, respectively before, during, after). Prevalence of glucocorticoids
use was broadly stable during pregnancy from 27.9% to 27.6% and 23.7% in the 1st,
2nd and 3rd trimesters, respectively, with a daily dose of about 5 mg. The number
of patients treated with non-recommended immunosuppressant during pregnancy gradually
decreased before pregnancy and then increased after delivery, whereas proportion of
systemic vasculitis flare, estimated from the glucocorticoids daily dose, did not
increase significantly during pregnancy.
Conclusion
Immunosuppressants and glucocorticoids use decreased before pregnancy and remained
stable throughout, suggesting a vasculitis control during this period. Our findings
support the importance of pre-conceptional consultations to review medications, and
switch not-recommended and teratogenic medications to drugs considered being safe
during pregnancy.
Keywords
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Article info
Publication history
Published online: January 24, 2023
Accepted:
January 12,
2023
Received in revised form:
January 10,
2023
Received:
October 14,
2022
Identification
Copyright
© 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
