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My daughter has been in remission from PAN for five years. She is 24 years old and seven weeks pregnant. We need as much information that we can gather about risk. Please help us.
Thank you very much.

Dr. Karen:

Your question is a common one. Below is some of the information I have been able to gather.

There are little studies on this as most PAN(a form of systemic vasculitis) patients are 40 or over and males are more likely to have PAN than females. Most of the studies lump the different vasculitis together as that is all the information we have. We assume that they are likely to respond similarly. There are some case reports. Some are related to MPA(microscopic polyarteritis) which tends to present later than PAN and more likely has renal and lung involvement at presentation. There are several potential complications. First many of the medications used to treat PAN can cause infertility. Second the medication is usually not safe for the fetus. If you are in remission, it is not clear whether pregnancy can cause a flair of the vasculitis.

The vasculitis (PAN) itself can compromise the blood supply to the placenta, causing miscarriage, or premature birth. The vasculitis can also in itself increase the chance of a blood clot otherwise known as a DVT(Deep vein thrombosis) which could move to the lung causing a PE (pulmonary embolism) which could result in the death of the mother. There also appears to be in increase in the chance of maternal complications near term such as pre-eclampsia or eclampsia. There have been reports of normal births with vasculitis but there are case reports of women who die due to complication of treatment of the vasculitis such as overwhelming infection. This may sound grim but the last potential complication is transferring the vasculitis to the baby.

The antibody or what ever causes PAN can cross the placenta, it appears not to be temporary as there is a case of a child who had the vasculitis until the age 7. This appears to be the potential complications. There are not very many studies mostly case reports which means that when a patient presents with something unusual it will be written up in a journal so that other doctors can learn from the experience. It may be just an individual experience but at this time that is all we have to go with. I hope this is helpful although not hopeful.

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