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Objective <p>To evaluate maternal–fetal outcomes and therapeutic efficacy in Takayasu arteritis (TA)-complicated pregnancies through integrated retrospective analysis and meta-analytic synthesis.</p> Methods <p>A dual-design study was conducted: (1) retrospective analysis of 20 pregnancies (17 patients) at West China Second Hospital (2012–2024), stratifying TA phases (acute/prolonged/stable); (2) systematic review with random-effects meta-analysis of 16 studies (568 pregnancies globally). Clinical data encompassed maternal–fetal profiles, TA-specific variables, laboratory metrics (hematologic/coagulation parameters), and therapies (glucocorticoids /immunosuppressants /antihypertensives). Outcomes were compared against normative standards using t-tests, Wilcoxon, chi-square, and meta-regression.</p> Results <p>Among 20 pregnancies (median maternal age 28.5&#xa0;years), 50% had at least one obstetric complication, with arterial stenosis (80%) and hypertension (40%) predominant. Meta-analysis revealed 42.6% adverse outcomes: gestational hypertension (26.1%), fetal growth restriction (17.7%), and preterm delivery (13.6%). Hematological analysis (<i>n</i> = 20) showed elevated WBC, PCT, TT, fibrinogen, urinary protein, and ALT (all <i>P</i> &lt; 0.05), alongside reduced PT, albumin, and bilirubin (<i>P</i> &lt; 0.05). Regarding the analysis results of inflammatory indicators, CRP (prepartum) (95%CI = 0.969–1.034, OR = 1.001), CRP (postpartum) (95%CI = 0.920–1.217, OR = 1.058), and ESR (95%CI = 0.952–1.101, OR = 1.024) showed no statistically significant association with pregnancy outcomes. Neither pre-pregnancy nor gestational glucocorticoids (prednisone vs methylprednisolone) or immunosuppressants significantly reduced complications (all RR 95% CI crossed 1; <i>P</i> &gt; 0.05). Antihypertensive therapy showed no correlation with preeclampsia (<i>P</i> &gt; 0.05).</p> Conclusion <p>TA significantly elevates maternal–fetal risks, driving hypertension, growth restriction, and preterm birth via vasculopathic-inflammatory pathways. Postpartum hypercoagulability (↑fibrinogen, ↓prothrombin time) necessitates multidisciplinary coagulation monitoring and mandatory thromboprophylaxis.</p>

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Maternal–fetal outcomes and therapeutic strategies in pregnancies complicated by Takayasu arteritis: a comprehensive analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月4日

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  • Wangjin Chen,
  • Ruilian Xie,
  • Yushuang Xiao,
  • Ziyi Cheng,
  • Lechen Wang,
  • Xiaoyi Hu,
  • Hongyu Jin,
  • Man Zhang

摘要

Objective

To evaluate maternal–fetal outcomes and therapeutic efficacy in Takayasu arteritis (TA)-complicated pregnancies through integrated retrospective analysis and meta-analytic synthesis.

Methods

A dual-design study was conducted: (1) retrospective analysis of 20 pregnancies (17 patients) at West China Second Hospital (2012–2024), stratifying TA phases (acute/prolonged/stable); (2) systematic review with random-effects meta-analysis of 16 studies (568 pregnancies globally). Clinical data encompassed maternal–fetal profiles, TA-specific variables, laboratory metrics (hematologic/coagulation parameters), and therapies (glucocorticoids /immunosuppressants /antihypertensives). Outcomes were compared against normative standards using t-tests, Wilcoxon, chi-square, and meta-regression.

Results

Among 20 pregnancies (median maternal age 28.5 years), 50% had at least one obstetric complication, with arterial stenosis (80%) and hypertension (40%) predominant. Meta-analysis revealed 42.6% adverse outcomes: gestational hypertension (26.1%), fetal growth restriction (17.7%), and preterm delivery (13.6%). Hematological analysis (n = 20) showed elevated WBC, PCT, TT, fibrinogen, urinary protein, and ALT (all P < 0.05), alongside reduced PT, albumin, and bilirubin (P < 0.05). Regarding the analysis results of inflammatory indicators, CRP (prepartum) (95%CI = 0.969–1.034, OR = 1.001), CRP (postpartum) (95%CI = 0.920–1.217, OR = 1.058), and ESR (95%CI = 0.952–1.101, OR = 1.024) showed no statistically significant association with pregnancy outcomes. Neither pre-pregnancy nor gestational glucocorticoids (prednisone vs methylprednisolone) or immunosuppressants significantly reduced complications (all RR 95% CI crossed 1; P > 0.05). Antihypertensive therapy showed no correlation with preeclampsia (P > 0.05).

Conclusion

TA significantly elevates maternal–fetal risks, driving hypertension, growth restriction, and preterm birth via vasculopathic-inflammatory pathways. Postpartum hypercoagulability (↑fibrinogen, ↓prothrombin time) necessitates multidisciplinary coagulation monitoring and mandatory thromboprophylaxis.