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Pregnancy in women with a history of K awasaki disease: management and outcomes
Author(s) -
Gordon CT,
JimenezFernandez S,
Daniels LB,
Kahn AM,
Tarsa M,
Matsubara T,
Shimizu C,
Burns JC,
Gordon JB
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12685
Subject(s) - medicine , pregnancy , offspring , population , disease , kawasaki disease , obstetrics , family history , pediatrics , surgery , genetics , environmental health , biology , artery
Objective To characterise the obstetrical management and outcomes in a series of women with a history of Kawasaki disease ( KD ) in childhood. Design Retrospective case series. Setting Tertiary healthcare setting in the USA . Population Women with a history of KD in childhood. Methods Women completed a detailed health questionnaire and participated in research imaging studies as part of the San Diego Adult KD Collaborative Study. Main outcome measures Obstetrical management, complications during pregnancy and delivery, and infant outcomes. Results Ten women with a history of KD in childhood carried a total of 21 pregnancies to term. There were no cardiovascular complications during labour and delivery despite important cardiovascular abnormalities in four of the ten subjects. Pregnancy was complicated by pre‐eclampsia and the post‐partum course was complicated by haemorrhage in one subject each. Two of the 21 progeny subsequently developed KD . Conclusions Women with important cardiovascular sequelae from KD in childhood should be managed by a team that includes both a maternal–fetal medicine specialist and a cardiologist. Pre‐pregnancy counselling should include delineation of the woman's current functional and structural cardiovascular status and appropriate adjustment of medications, but excellent outcomes are possible with appropriate care. Review of the English and Japanese literature on KD and pregnancy revealed the occurrence of myocardial infarction during pregnancy in women with missed KD and aneurysms that were not diagnosed until their acute event. Our study highlights the need for counselling with regard to the increased genetic risk of KD in offspring born to these mothers.