Background: Takayasu arteritis (TAK) is a rare large-vessel vasculitis associated with significant maternal and fetal morbidity (1). In pregnancy, TAK increases the risks of miscarriage, hypertension and pre-eclampsia compared with the general population (2, 3).
Aims: To do a systematic literature review (SLR) evaluating the clinical characteristics, maternal and fetal outcomes, and management of TAK in pregnancy.
Method: SLR was performed according to PRISMA guidelines. MEDLINE (OVID) and Embase (OVID) were searched using keywords and MeSH terms related to Takayasu arteritis, large-vessel vasculitis, and pregnancy. English-language original studies involving pregnant adults (≥ 18 years) with confirmed TAK were included, including case reports and subgroup analysis. Reviews, meta-analysis, editorial, letters, conference abstracts, comments, and animal studies were excluded. Two reviewers independently screened studies, extracted data according to predefined templates, and assessed risk of bias using the JBI critical appraisal tool. Disagreements resolved by consensus.
Results: Of 169 identified articles, 40 studies met inclusion criteria, comprising 23 case reports, 13 retrospective cohort studies, two cross-sectional studies, and two case-control studies. Clinical presentation varied according to vascular involvement. Multimodal imaging, including ultrasound, CT, echocardiography, MRI, and PET, was frequently used for diagnosis. Maternal complications included hypertension (12.1-67.7%), pre-eclampsia (8.3-20.6%), increased caesarean delivery (31.4-88.9%). Fetal complications included prematurity (11.1-32.60%) and fetal growth restriction (10-28.8%).
Conclusions: TAK in pregnancy presents with heterogeneous clinical features and is associated with substantial maternal and fetal morbidity, particularly hypertension, pre-eclampsia, caesarean delivery, prematurity, and fetal growth restriction.