67. Fertility, Early Menopause, and Pregnancy outcomes of patients with Takayasu's arteritis

Background: Reproductive health of Takayasu’s arteritis (TA) is an important issue since it is commonly seen at childbearing ages. Systemic inflammation and used treatments in TA, may affect male and female reproductive organs leading to infertility, maternal and fetal morbidity and also early menopause. A novel proposed disease clusters for TA (C1: Abdominal Predominant, C2: Aortic Arch Predominant, C3: Focal Disease) was recently published. Pregnancy complications might differ among these subtypes. Objectives: We aimed to evaluate the fertility, early menopause and pregnancy (PG) outcomes of TA patients before TA diagnosis and after TA diagnosis. Additionally, pregnancy morbidities after TA diagnosis, were detail analysed for each TA cluster. Methods: In the prospective database of the Hacettepe University Vasculitis Research Centre (HUVAC), 202 TA patients (female =184) meeting the 1990 ACR criteria were registered by the end of February 2020. Demographic and clinical features, comorbidities, distribution of vascular involvement, obstetrical histories and outcomes were retrospectively evaluated. TA patients were classified according to a novel proposed disease clusters (C1: Abdominal Predominant, C2: Aortic Arch Predominant, C3: Focal Disease). Infertility was defined as not being able to get pregnant after one year (or longer) of unprotected sex. Menopause before the age of 45 was defined as early menopause (EM). Results: 120 patients who could be reached out gynaecological records and marriage status, were included into the study. Of 96 married TA patients, 12(12.5%) had infertility. We identified 235 pregnancies in 82 female TA patients (beforeTA diagnosis: 200 pregnancies, after TA diagnosis: 35- two patients were diagnosed during pregnancy. Compared to before TA diagnosis, maternal complications were significantly more common in after TA group [22 (11.0%) vs. 9 (25.7%), p=0.048]. Most frequent maternal complication was gestational hypertension and was seen in 4 (12.1%) patients (Table 1). Fetal complications were frequent in both before and after TA diagnosis [21.5%vs.34.2%, p=0.18 respectively] and seen as prematurity, IUGR and LBW. According to novel disease subsets, afterTA patients classified into C1 (n=3; 15.7%), C2 (n=9; 47.3%) and C3 (n=6; 31.5%). One patient could not be classified. There was no difference for the obstetrical outcomes among these subgroups. 20 (16.7%) of 120 patients had early menopause. Conclusion: Compared to general population in Turkey, infertility (12.5% vs. 8.1%) and early menopause ratios (16.7% vs. 7.6%) seem to be increased in TA patients. (1,2). Pregnancies after TA diagnosis had more maternal complications. Fetal complications were more frequent not only after TA but also before TA diagnosis. Chronic inflammation even before TA diagnosis might have impact on increased infertility and fetal complications. Table 1. Pregnancies Before TA (n=200) Pregnancies After TA (n=35) Number of Patients 71 19 Not performed Age at first pregnancy 21.7 (5.0) 27.6 (5.0) Age at TA diagnosis, years mean (SD) 38.2 (13.1) 24.0 (6.6) Disease duration, year mean (SD) (TA diagnosis-1. Pregnancy) NA 4.2 (3.6) Comorbidities/CV Risk factors n(%) n (%) p - Smoking - Dyslipidaemia - Hypertension - Diabetes mellitus 22 (31) 14 (19.7) 29 (40.8) 8 (11.3) 3 (15.8) 1 (5.3) 9 (47.4) 0 (0) >0.05 Maternal Complications n (%) Numbers of pregnancies with any maternal complications 22 (11.0) 9 (25.7) 0.048 - Gestational hypertension - PROM - GDM - Bleeding (Antepartum/postpartum) - Preeclampsia - Infection - Placenta previa - Placental abruption 6 (3.0) 6 (3.0) 0 (0) 6 (3.0) 0 (0.0) 5 (2.5) 0 (0) 0 (0) 4 (12,1) 1 (3.0) 1 (2.9) 2 (6.1) 0 (0.0) 1 (3.0) 1 (3.0) 0 (0) Not performed Fetal Complications n (%) p Numbers of pregnancies with any fetal complications 43 (21.5) 12 (34.2) 0.180 - LBW - IUGR - Preterm birth - CNS complications - Cardiovascular complications - RDS_BPD - NICU admission - Other - Neonatal death - Retinopathy of prematurity - Necrotizing enterocolitis - Stillbirth 16 (8.0) 20 (1.0) 13 (6.5) 2 (1.0) 3 (1.5) 4 (2.0) 12 (6.0) 5 (2.5) 5 (2.5) 1 (0.5) 0 (0) 7 (3.5) 6 (18.2) 6 (17.1) 7 (21.2) 1 (3.0) 0 (0) 0 (0) 1 (3.0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Not performed Delivery n (%) P Vaginal delivery 128 (64) 6 (18.2) <0.001 Cesarean delivery 24 (12) 15 (42.9)