Evaluation of obstetric outcomes in Brazilian pregnant women with Takayasu arteritis

Abstract Objective Takayasu arteritis (TAK) is a rare chronic granulomatous vasculitis that affects large vessels and usually begins in women of childbearing age, so it is not uncommon for pregnancies to occur in these patients. However, there is limited information about these pregnancies, with reports of adverse maternal and obstetric outcomes. The objective of this study is to evaluate adverse maternal, fetal and neonatal events in pregnant patients with TA. Methods This is a cross-sectional study with retrospective data collection. We reviewed 22 pregnancies in 18 patients with TAK, according to the American College of Rheumatology criteria, that were followed up in a high-risk prenatal clinic specialized in systemic autoimmune diseases and thrombophilia (PrAT) at Hospital Universitário Pedro Ernesto, from 1998 to 2021. Results In twenty-two pregnancies, the mean age of patients was 28.09 years and the mean duration disease was 10.9 years. Of the 18 patients with TAK studied, only one had the diagnosis during pregnancy and had active disease. All other patients had a previous diagnosis of TAK and only 3 had disease activity during pregnancy. Twelve patients (66.6%) had previous systemic arterial hypertension and eleven (61.1%) had renal involvement. Among maternal complications, eight patients (36.3%) developed preeclampsia and six (27.2%) had uncontrolled blood pressure without proteinuria, while 10 (45%) had puerperal complications. Four (18.1%) births were premature, all due to severe preeclampsia and eight newborns (34.7%) were small for gestational age. When all maternal and fetal/neonatal outcomes included in this study were considered, only 6 (27.2%) pregnancies were uneventful. Conclusion Although there were no maternal deaths or pregnancy losses in this study, the number of adverse events was considerably high. Hypertensive disorders and small for gestational age newborns were more common than general population, while the number of patients with active disease was low. These findings suggest that pregnancies in patients with TAK still have several complications and a high-risk prenatal care and delivery are necessary for these patients.

Risk factors associated with infections in pregnant women with systemic lupus erythematosus

SUMMARY OBJECTIVE: The aim of this study was to analyze the occurrence and risk factors associated with infections during pregnancy in patients with systemic lupus erythematosus. METHODS: This is a retrospective cohort study using the data of pregnant women who were followed up between 2011 and 2018 at a university hospital. RESULTS: The data of 221 pregnant women with systemic lupus erythematosus were analyzed. The incidence of infections was 22.6% (50/221), with the urinary tract being the most frequent site of infection (32/221, 14.5%) followed by the respiratory tract (15/221, 6.8%). The bivariate analysis showed that active disease, hematological systemic lupus erythematosus, reduced complement, and use of prednisone ≥5 and ≥10 mg increased the chance of infection during early pregnancy (p=0.05, p=0.04, p=0.003, p=0.008, and p=0.02, respectively), while disease activity and anti-DNA positivity increased it at the end of pregnancy (p=0.03 and p=0.04, respectively). Prednisone at a dose ≥5 mg increased the chance of infection in the beginning (p=0.01) and at the end of pregnancy (p=0.008). Multivariate analysis showed that increasing the dose of prednisone from 5 to 10 mg tripled the chance of developing infections in pregnant women with lupus (p=0.02). CONCLUSION: The study showed an increased chance of infections in pregnant women with systemic lupus erythematosus and it was associated with the use of prednisone.

NK cells in pregnant patients with SLE: a preliminary study / Estudo-piloto: células NK nas gestantes com LES

O sistema imune inato desempenha papel central na reprodução, tendo as células NK participação marcante. Durante a gravidez, seu comportamento pode esclarecer pontos cruciais na patogênese das complicações que podem ocorrer em gestantes com LES. OBJETIVO: Quantificar as células NK circulantes e sua viabilidade em gestantes com LES. MATERIAL E MÉTODOS: Avaliaram-se amostras de sangue de quatro grupos de dez pacientes cada: 1 GLES: Gestantes com LES; 2 PLES: Pacientes com LES não gestantes; 3 Gcontroles: Gestantes controles; 4 Controles: Mulheres não gestantes saudáveis. Em todas as pacientes, a quantidade e a viabilidade das células NK foram medidas por citometria de fluxo, assim como por apoptose total por coloração para anexina V e iodeto de propidium. RESULTADOS: Devido à variabilidade dos resultados, a mediana de cada grupo foi utilizada para avaliar: porcentagem CD56+ [GLES (0,10), PLES (0,12), Gcontroles (0,15), Controles (0,08)]; apoptose total [GLES (0,06), PLES (0,04), Gcontroles (0,11), Controles (0,11)]. Os resultados da contagem de células vivas tiveram baixa variabilidade, por isso média e desvio-padrão foram utilizados para comparação: [GLES (0,91 ± 0,06), PLES (0,95 ± 0,03), Gcontroles (0,86 ± 0,11), Controles (0,88 ± 0,08). CONCLUSÃO: Apesar de não terem alcançado valor de significância estatística, o percentual de apoptose total nos grupos com LES foi menor que o dos controles, e a porcentagem de células vivas foi maior. Isso sugere que, em pacientes com LES, grávidas ou não, as células NK têm vida útil prolongada (ou tem turnover menor/diferente), o que indica um maior estímulo imune, fazendo com que as células NK levem mais tempo para ativar o processo de apoptose.

The innate immune system plays an important role in reproduction, with marked involvement of NK cells. These cells behavior during pregnancy may clarify crucial points in the pathogenesis of complications that may occur in pregnant women with SLE. OBJECTIVE: To measure the amount of circulating NK cells and their viability in pregnant SLE patients. MATERIALS AND METHODS: Blood samples from four groups of ten patients each were evaluated: 1. GLES: Pregnant SLE patients; 2. PLES: Non-pregnant SLE patients; 3. Gcontrols: Pregnant controls; 4. Controls: Healthy non-pregnant women. In all patients the amount and viability of NK cells was measured by flow cytometry, as well as the total apoptosis by annexin V and propidium iodite staining. RESULTS: Due to the great variability, median of each group was used for evaluation: CD56+ count [GLES (0.10), PLES (0.12), Gcontrols (0.15), Controls (0.08)]; total apoptosis (addition of initial and late apoptosis to total number of dead cells) [GLES (0.06), PLES (0.04), Gcontrols (0.11), Controls (0.11)]. The results for live cells count had low variability, so the averages and standard deviations were used for comparisons: [GLES (0.91±0.06), PLES (0.95±0.03), Gcontrols (0.86±0.11), Controls (0.88+0.08)]. CONCLUSION: Although not statistically significant, the total apoptosis in the SLE groups was lower than in the control groups, and the live cell count was higher. This suggests that in SLE patients, pregnant or not, the NK cells have a prolonged life cycle (or have a lower/different turnover), and that there may be a higher immune stimulus making the NK cells take longer to activate the apoptosis process.

Imunidade na gestacão normal e na paciente com lúpus eritematoso sistêmico (LES) / Immunity in the normal pregnancy and in the patient with systemic lupus erythematosus (SLE)

A gravidez é uma condicão fisiológica na qual ocorrem várias mudancas imunoendócrinas com a finalidade de facilitar a imunossupressão e a tolerância aos antígenos paternos e fetais. Na gravidez humana normal existe uma relativa supressão de citocinas tipo Th1 na resposta dos linfócitos, levando a uma prevalência na resposta do tipo Th2. No LES, onde prevalece a resposta imune do tipo Th2, a gravidez pode estar relacionada com a ativacão da doenca. Este artigo é uma revisão dessas alteracões relacionadas com a resposta imune durante a gestacão normal e na da paciente com LES.