The Arterial Odyssey: Navigating Pregnancy in Takayasu Arteritis - A Case Series

Abstract

Background: Takayasu Arteritis (TA) is a chronic, idiopathic, granulomatous vasculitis primarily affecting the aorta and its branches. The disease predominantly affects young women of reproductive age, creating unique challenges during pregnancy. Objective: To describe the clinical profile, disease characteristics, and pregnancy outcomes in women with Takayasu arteritis, and to evaluate factors associated with adverse maternal and fetal outcomes. Methods: This retrospective case series was conducted at Government Rajaji Hospital, Madurai, over one year. Six pregnant women diagnosed with Takayasu arteritis based on American College of Rheumatology (ACR) criteria were included. Data was collected from the case sheets and high-risk registers. Results: The mean age was 24.1 years (range 21–28). Three women (50%) had active disease during pregnancy. Hypertension was the most common maternal complication (87%), with severe preeclampsia observed in two cases. Fetal complications included fetal growth restriction, stillbirth, and miscarriage. One patient developed azathioprine-induced pancytopenia postpartum. Cesarean section was performed in three cases for obstetric and maternal indications, while one patient had an instrumental vaginal delivery. Conclusion: Pregnancy in Takayasu arteritis is a high risk and requires multidisciplinary management. Preconceptional optimisation of disease activity, strict blood pressure control, and the use of safe immunosuppressive therapy are critical for improving maternal and foetal outcomes.