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a Department of
Internal Medicine, Hôpital de Bicêtre, 78 avenue du general
leclerc, 94270 Le Kremlin-Bicetre, France, b Department of Internal Medicine, Groupe
Hospitalier Pitié-Salpêtrière, 83 boulevard de l'hôpital,
75651 Paris Cedex 13, France, c Department of Gynecology-Obstetrics, Groupe
Hospitalier Pitié-Salpêtrière
Correspondence to: Dr Auzary
Accepted for publication 9 March 2000
Five cases of pregnancy occurring in three women with
previously diagnosed Wegener's granulomatosis are described. The
disease was diffuse in one case and localised in the other. Initial
treatment consisted of a combination of corticosteroids and intravenous cyclophosphamide in two women, and methotrexate in one. Four
pregnancies ended in live births despite pre-eclampsia in two cases.
One therapeutic abortion was induced because of encephalocele.
Comparable reported cases were reviewed to examine the implications of
immunosuppressive treatment on the fetus. A relapse occurred during
pregnancy in 40% of the cases, but in 25% if only pregnancies
beginning during inactive disease were taken into account. No other
indicator for maternal and fetal outcome was obvious. Pregnancy should
be planned after complete disappearance of disease activity. In the
case of a relapse a combination of immunosuppressive drugs and
corticosteroids should be chosen rather than corticosteroids alone
because the outcome of pregnancy is poor in cases of undertreatment.
Prematurity remains common.
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