Fertility, early menopause and pregnancy outcomes of patients with Takayasu’s arteritis

Published:January 21, 2023DOI:



      The reproductive health of patients with Takayasu’s arteritis (TA) is an important issue. Systemic inflammation and treatments used in TA may affect female reproductive organs, leading to infertility, maternal and fetal morbidity, and early menopause. This study aimed to evaluate fertility, early menopause and pregnancy outcomes of patients before and after TA diagnosis. In addition, pregnancy morbidities following TA diagnosis were analysed for each cluster.

      Study design

      Two hundred and two patients with TA (184 females) who met the 1990 American College of Rheumatology criteria were registered in the prospective database of Hacettepe University Vasculitis Research Centre by the end of February 2020. Demographic and clinical features, comorbidities, distribution of vascular involvement, obstetric histories and outcomes were evaluated retrospectively. Patients with TA were classified according to novel proposed disease clusters. Early menopause was defined as menopause before 45 years of age.


      One hundred and twenty-one female patients with TA, for whom gynaecological records and marriage status could be obtained, were included in the study. Ninety-seven patients were married, of whom 12 (12.5%) patients were infertile. In total, there were 238 pregnancies in 83 female patients with TA: 203 before TA diagnosis, 35 after TA diagnosis, and two patients were diagnosed during pregnancy. Compared with the pre-diagnosis group, maternal complications were significantly more common in the post-diagnosis group [23 (11.3%) vs 9 (25.7%); p=0.048]. The most common maternal complication was gestational hypertension (12.1%). Fetal complications were common in both groups (21.5% pre-diagnosis vs 34.2% post-diagnosis; p=0.18), and included prematurity, intrauterine growth retardation and low birth weight. According to novel disease subsets, post-diagnosis patients were classified as C1 (n=3, 15.7%), C2 (n=9, 47.3%) or C3 (n=6, 31.5%). One patient could not be classified. There was no difference in obstetric outcomes between these subgroups. Early menopause was observed in 20 (16.5%) of 121 patients, but some patients had not yet reached 45 years of age.


      Infertility was higher in patients with TA in comparison with the general population in Turkey (12.5% vs 8.6%), and the early menopause rate was lower in patients with TA (16.7% vs 36.1%). Pregnancies following a diagnosis of TA had more maternal complications than pre-diagnosis pregnancies. Fetal complications were more common both pre- and post-diagnosis. Chronic inflammation before TA diagnosis may lead to increased infertility and fetal complications.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Comarmond C.
        • Mirault T.
        • Biard L.
        • Nizard J.
        • Lambert M.
        • Wechsler B.
        • et al.
        Takayasu arteritis and pregnancy. Arthritis.
        Rheumatol. 2015; 67: 3262-3269
        • Vanoli M.
        • Daina E.
        • Salvarani C.
        • Sabbadini M.G.
        • Rossi C.
        • Bacchiani G.
        • et al.
        Takayasu's arteritis: a study of 104 Italian patients.
        Arthritis Rheum. 2005; 53: 100-107
        • Singh N.
        • Tyagi S.
        • Tripathi R.
        • Mala Y.M.
        Maternal and fetal outcomes in pregnant women with Takayasu aortoarteritis: does optimally timed intervention in women with renal artery involvement improve pregnancy outcome?.
        Taiwan J Obstet Gynecol. 2015; 54: 597-602
        • David L.S.
        • Beck M.M.
        • Kumar M.
        • Rajan S.J.
        • Danda D.
        • Vijayaselvi R.
        Obstetric and perinatal outcomes in pregnant women with Takayasu's arteritis: single centre experience over five years.
        J Turk Ger Gynecol Assoc. 2020; 21: 15-23
        • Abisror N.
        • Mekinian A.
        • Hachulla E.
        • Lambert M.
        • Morel N.
        • Chapelon C.
        • et al.
        Analysis of risk factors for complications and adverse obstetrical outcomes in women with Takayasu arteritis: a French retrospective study and literature review.
        Clin Rheumatol. 2020; 39: 2707-2713
        • Gupta L.
        • Misra D.P.
        • Ahmed S.
        • Jain A.
        • Zanwar A.
        • Lawrence A.
        • et al.
        Poor obstetric outcomes in Indian women with Takayasu arteritis.
        Adv Rheumatol. 2020; 60
        • Assad A.P.L.
        • da Silva T.F.
        • Bonfa E.
        • Pereira R.M.R.
        Maternal and neonatal outcomes in 89 patients with Takayasu arteritis (TA): comparison before and after the TA diagnosis.
        J Rheumatol. 2015; 42: 1861-1864
        • Mandal D.
        • Mandal S.
        • Dattaray C.
        • Banerjee D.
        • Ghosh P.
        • Ghosh A.
        • et al.
        Takayasu arteritis in pregnancy: an analysis from eastern India.
        Arch Gynecol Obstet. 2012; 285: 567-571
        • Wong V.C.W.
        • Wang R.Y.C.
        • Tse T.F.
        Pregnancy and Takayasu's arteritis.
        Am J Med. 1983; 75: 597-601
        • Tanaka H.
        • Tanaka K.
        • Kamiya C.
        • Iwanaga N.
        • Yoshimatsu J.
        Analysis of pregnancies in women with Takayasu arteritis: complication of Takayasu arteritis involving obstetric or cardiovascular events.
        J Obstet Gynaecol Res. 2014; 40: 2031-2036
        • Gudbrandsson B.
        • Wallenius M.
        • Garen T.
        • Henriksen T.
        • Molberg Ø.
        • Palm Ø.
        Takayasu arteritis and pregnancy: a population-based study on outcomes and mother/child-related concerns.
        Arthritis Care Res. 2017; 69: 1384-1390
        • Hidaka N.
        • Yamanaka Y.
        • Fujita Y.
        • Fukushima K.
        • Wake N.
        Clinical manifestations of pregnancy in patients with Takayasu arteritis: experience from a single tertiary center.
        Arch Gynecol Obstet. 2012; 285: 377-385
        • Kirshenbaum M.
        • Simchen M.J.
        Pregnancy outcome in patients with Takayasu's arteritis: cohort study and review of the literature.
        J Matern Fetal Neonatal Med. 2018; 31: 2877-2883
        • Gasch ORIOL
        • Vidaller ANTONIO
        • Pujol RAMON
        Takayasu arteritis and pregnancy from the point of view of the internist.
        J Rheumatol. 2009; 36: 1554-1555
        • Johnston S.L.
        • Lock R.J.
        • Gompels M.M.
        Takayasu arteritis: a review.
        J Clin Pathol. 2002; 55: 481-486
        • Matsumura A.
        • Moriwaki R.
        • Numano F.
        Pregnancy in Takayasu arteritis from the view of internal medicine.
        Heart Vessels Suppl. 1992; 7: 120-124
      1. Goel R, Gribbons KB, Carette S, et al. Derivation of an angiographically based classification system in Takayasu's arteritis: an observational study from India and North America. Rheumatology 2020;59:1118–27.

        • Davis S.R.
        • Baber R.J.
        Treating menopause – MHT and beyond.
        Nat Rev Endocrinol. 2022; 18: 490-502
        • Vander Borght M.
        • Wyns C.
        Fertility and infertility: definition and epidemiology.
        Clin Biochem. 2018; 62: 2-10
        • Sharma B.K.
        • Jain S.
        • Vasishta K.
        Outcome of pregnancy in Takayasu arteritis.
        Int J Cardiol. 2000; 75: S159-S162
        • Alpay-Kanitez N.
        • Omma A.
        • Erer B.
        • et al.
        Favourable pregnancy outcome in Takayasu arteritis: a single-centre experience.
        Clin Exp Rheumatol. 2015; 33: S7-S
        • Suri V.
        • Aggarwal N.
        • Keepanasseril A.
        • Chopra S.
        • Vijayvergiya R.
        • Jain S.
        Pregnancy and Takayasu arteritis: a single centre experience from North India.
        J Obstet Gynaecol Res. 2010; 36: 519-524
        • Ishikawa K.
        • Matsuura S.
        Occlusive thromboaortopathy (Takayasu's disease) and pregnancy. Clinical course and management of 33 pregnancies and deliveries.
        Am J Cardiol. 1982; 50: 1293-1300
        • Sarac M.
        • Koc I.
        Prevalence and risk factors of infertility in Turkey: evidence from demographic and health surveys, 1993–2013.
        J Biosoc Sci. 2018; 50: 472-490
        • Naçar M.
        • Baykan Z.
        • Öztürk A.
        • Çetinkaya F.
        Age at menopause and associated factors in central Anatolia.
        Turkey. Gynecol Obstet Reprod Med. 2007; 13: 168-173
        • Marwah S.
        • Rajput M.
        • Mohindra R.
        • Gaikwad H.S.
        • Sharma M.
        • Topden S.R.
        Takayasu's arteritis in pregnancy: a rare case report from a tertiary care infirmary in India.
        Case Rep Obstet Gynecol. 2017; 2017: 1-6