Due to the relatively recent discovery of KD and lack of awareness of the disease, research into the effects of the disease during and following pregnancy is scarce and sample sizes in studies are generally small. All cardiovascular sequelae of KD pose risks to the mother during pregnancy, labour and delivery, and medications used to manage these conditions may pose risks to the foetus.

 

In the most recent study of 10 women with a history of KD, only one experienced an obstetrical complication of post-partum haemorrhage, which was possibly related to premature re-institution of heparin therapy after delivery (1). This highlights the need for more studies into the management of KD and associated cardiovascular sequelae in order to develop evidence-based guidelines for obstetricians to support the mothers and babies affected by KD.

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Two women in this study delivered infants that developed KD at two and five months. Both mothers were unaware of the genetic component to susceptibility to KD and were unfamiliar with the characteristic clinical signs of KD because they had no personal memory of their illness in childhood. This underscores the need to improve knowledge of the disease’s genetic risk in people with history of the disease.

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The study also reviewed reports of the management, delivery method and outcomes in 52 Japanese women with a history of KD. Obstetrical complications were reported in 9.7% of the deliveries including premature rupture of membranes, preterm labor, and post-partum hemorrhage. Cardiovascular complications were also reported in 9.6% of the women. Of the 72 infants, 63 were delivered at term and were healthy; two infants were delivered prematurely at 33 weeks by caesarean section due to maternal distress; five additional infants were born prematurely; two additional infants had congenital abnormalities consisting of ventricular septal defect (hole in the heart) and agenesis of the corpus callosum.

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1. Gordon CT, Jimenez-Fernandez S, Daniels LB, et al. Pregnancy in women with a history of Kawasaki disease: management and outcomes. BJOG. 2014;121(11):1431–1438. doi:10.1111/1471-0528.12685