Rationale & Objective: Pregnancy, delivery, and neonatal outcomes in women with complement
-mediated thrombotic microangiopathy (cTMA) have not been well described. A better
understanding of these outcomes is necessary to provide women with competent pregnancy
counseling.Study Design: Cohort study.Setting and Participants: Women with a history
of cTMA and pregnancies enrolled into the Vienna thrombotic microangiopathy cohort.Exposure:
New onset or relapses of cTMA.Outcomes: Pregnancy, delivery, and neonatal outcomes
of pregnancies in women (a) before cTMA manifestation, (b) complicated by pregnancy-associated
cTMA (P-cTMA), and (c) after first manifestation of cTMA or P-cTMA.Analytical Approach:
Mixed models were used to adjust the comparison of pregnancy, delivery, and neonatal
outcomes between conditions (before, with, and after cTMA) for repeated pregnancies
using the mother's ID as random factor. In addition, the fixed factors, mother's age
and neonate's sex, were used for adjustment. For (sex-adjusted and age-adjusted) centile
outcomes, only the mother's age was used. Adjusted odds ratios were derived from a
generalized linear mixed model with live birth as the outcome. Least squares means
and pairwise differences between them were derived from the linear mixed models for
the remaining outcomes.Results: 28 women reported 74 pregnancies. Despite higher rates
of fetal loss before the diag-nosis of P-cTMA and preterm births with P-cTMA, most
of the women were able to conceive suc-cessfully. Neonatal development in all 3 conditions
of pregnancies was excellent. Pregnancy and neonatal outcomes were better in women
with a pregnancy after the diagnosis of cTMA.Limitations: Although our data set comprises
a considerable number of 74 pregnancies, the effective sample size is lower because
only 28 mothers with multiple pregnancies were observed. The statistical power for
detecting clinically rele-vant effects was probably low. A recall bias for miscarriages
cannot be ruled out.Conclusions: Prepregnancy counseling of women with a history of
cTMA can be supportive of their desire to become
