Helpful elements for counseling a patient with a history of aHUS who wishes to plan a pregnancy
| Counseling a woman with a history of aHUS about pregnancy relies on the following information: . |
|---|
| 1. Pregnancy is no longer contraindicated in women with a history of aHUS. |
| The risk of relapse of aHUS during pregnancy or postpartum appears lower (∼25%) than formerly appreciated.83 |
| An efficient treatment (anti-C5 treatment such as eculizumab) is available. |
| 2. The risk of relapse of aHUS triggered by pregnancy is difficult to predict. |
| A prior uneventful pregnancy does not guarantee subsequent pregnancies will be free of relapse.21,83 |
| Women who do not carry a complement gene variant are not protected from pregnancy aHUS.21 |
| 3. An interval of ∼12 mo of aHUS remission and stabilized renal function is appropriate before pregnancy initiation. |
| 4. In women with prior aHUS, relapse of aHUS occurs more frequently during pregnancy than after delivery.21,23 |
| In the pre-anti-C5 treatment era, this was associated with a high risk of fetal death or preterm birth.83 |
| 5. CKD may be a limitation to pregnancy. |
| Residual severe CKD or hypertension after aHUS may worsen during pregnancy, with increased risk of preeclampsia or HELLP syndrome, ESRD, and fetal death.24,83 |
| 6. In case of aHUS relapse, prompt anti-C5 treatment initiation optimizes chances of patient’s full recovery and child’s full-term live birth. |
| 7. Prophylactic anti-C5 treatment is currently not recommended. |
| Anti-C5 treatment is usually not discontinued in women already treated prior to pregnancy (particularly renal transplant patients). |
| 8. Pregnancy in a woman with a history of aHUS remains a high-risk pregnancy. |
| Close multidisciplinary (obstetricians, nephrologists, neonatologists, and complement biologists) supervision from the first weeks of pregnancy and up to 3 mo postdelivery in high-risk pregnancy maternity clinic is mandatory. |
| Counseling a woman with a history of aHUS about pregnancy relies on the following information: . |
|---|
| 1. Pregnancy is no longer contraindicated in women with a history of aHUS. |
| The risk of relapse of aHUS during pregnancy or postpartum appears lower (∼25%) than formerly appreciated.83 |
| An efficient treatment (anti-C5 treatment such as eculizumab) is available. |
| 2. The risk of relapse of aHUS triggered by pregnancy is difficult to predict. |
| A prior uneventful pregnancy does not guarantee subsequent pregnancies will be free of relapse.21,83 |
| Women who do not carry a complement gene variant are not protected from pregnancy aHUS.21 |
| 3. An interval of ∼12 mo of aHUS remission and stabilized renal function is appropriate before pregnancy initiation. |
| 4. In women with prior aHUS, relapse of aHUS occurs more frequently during pregnancy than after delivery.21,23 |
| In the pre-anti-C5 treatment era, this was associated with a high risk of fetal death or preterm birth.83 |
| 5. CKD may be a limitation to pregnancy. |
| Residual severe CKD or hypertension after aHUS may worsen during pregnancy, with increased risk of preeclampsia or HELLP syndrome, ESRD, and fetal death.24,83 |
| 6. In case of aHUS relapse, prompt anti-C5 treatment initiation optimizes chances of patient’s full recovery and child’s full-term live birth. |
| 7. Prophylactic anti-C5 treatment is currently not recommended. |
| Anti-C5 treatment is usually not discontinued in women already treated prior to pregnancy (particularly renal transplant patients). |
| 8. Pregnancy in a woman with a history of aHUS remains a high-risk pregnancy. |
| Close multidisciplinary (obstetricians, nephrologists, neonatologists, and complement biologists) supervision from the first weeks of pregnancy and up to 3 mo postdelivery in high-risk pregnancy maternity clinic is mandatory. |
CKD, chronic kidney disease; ESRD, end-stage renal disease.