Pregnancy in women with a history of Kawasaki disease: management and outcomes

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 121; no. 11; pp. 1431 - 1438
• Main Authors: Gordon, CT, Jimenez‐Fernandez, S, Daniels, LB, Kahn, AM, Tarsa, M, Matsubara, T, Shimizu, C, Burns, JC, Gordon, JB
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.10.2014
• Subjects: Adult; Anticoagulation; Calcinosis - etiology; Calcinosis - pathology; Cardiovascular system; coronary artery aneurysms; Delivery, Obstetric - methods; Disease; Echocardiography; Female; Humans; Kawasaki disease; Magnetic Resonance Angiography; Middle Aged; Mothers; Mucocutaneous Lymph Node Syndrome - complications; Mucocutaneous Lymph Node Syndrome - pathology; Mucocutaneous Lymph Node Syndrome - therapy; Obstetrics; Pre-Eclampsia - etiology; Pre-Eclampsia - pathology; Pregnancy; Pregnancy Complications, Cardiovascular - etiology; Pregnancy Complications, Cardiovascular - pathology; Pregnancy Complications, Cardiovascular - therapy; Pregnancy Outcome; Questionnaires; Retrospective Studies; Surveys and Questionnaires; Tomography, X-Ray Computed; vasculitis; Womens history; United States > US; Japan; Anticoagulation; Kawasaki disease; coronary artery aneurysms; vasculitis; pregnancy
• ISSN: 1470-0328; 1471-0528; 1471-0528
• DOI: 10.1111/1471-0528.12685

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.