Pregnancy in Complement-Mediated Thrombotic Microangiopathy: Maternal and Neonatal Outcomes.
Thrombotic microangiopathy
aHUS
abortion
cTMA
complement system
delivery
live birth
miscarriage
neonatal outcomes
pregnancy
pregnancy counseling
Journal
Kidney medicine
ISSN: 2590-0595
Titre abrégé: Kidney Med
Pays: United States
ID NLM: 101756300
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
medline:
26
7
2023
pubmed:
26
7
2023
entrez:
26
7
2023
Statut:
epublish
Résumé
Pregnancy, delivery, and neonatal outcomes in women with complement-mediated thrombotic microangiopathy (cTMA) have not been well described. A better understanding of these outcomes is necessary to provide women with competent pregnancy counseling. Cohort study. Women with a history of cTMA and pregnancies enrolled into the Vienna thrombotic microangiopathy cohort. New onset or relapses of cTMA. Pregnancy, delivery, and neonatal outcomes of pregnancies in women (a) before cTMA manifestation, (b) complicated by pregnancy-associated cTMA (P-cTMA), and (c) after first manifestation of cTMA or P-cTMA. Mixed models were used to adjust the comparison of pregnancy, delivery, and neonatal outcomes between conditions (before, with, and after cTMA) for repeated pregnancies using the mother's ID as random factor. In addition, the fixed factors, mother's age and neonate's sex, were used for adjustment. For (sex-adjusted and age-adjusted) centile outcomes, only the mother's age was used. Adjusted odds ratios were derived from a generalized linear mixed model with live birth as the outcome. Least squares means and pairwise differences between them were derived from the linear mixed models for the remaining outcomes. 28 women reported 74 pregnancies. Despite higher rates of fetal loss before the diagnosis of P-cTMA and preterm births with P-cTMA, most of the women were able to conceive successfully. Neonatal development in all 3 conditions of pregnancies was excellent. Pregnancy and neonatal outcomes were better in women with a pregnancy after the diagnosis of cTMA. Although our data set comprises a considerable number of 74 pregnancies, the effective sample size is lower because only 28 mothers with multiple pregnancies were observed. The statistical power for detecting clinically relevant effects was probably low. A recall bias for miscarriages cannot be ruled out. Prepregnancy counseling of women with a history of cTMA can be supportive of their desire to become pregnant.
Identifiants
pubmed: 37492116
doi: 10.1016/j.xkme.2023.100669
pii: S2590-0595(23)00085-7
pmc: PMC10363558
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100669Informations de copyright
© 2023 The Authors.
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