Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis

Smeele, H. T.; Dolhain, Radboud J E M

doi:10.1016/j.semarthrit.2019.09.010

Cited by 35 publications

(33 citation statements)

References 20 publications

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“…Increased risks associated with TNFi of preterm birth, caesarean section and small for gestational age children have been previously reported (Bröms et al, 2020). However, given the study design and the fact that high disease activity is known to negatively influence pregnancy outcomes (Smeele and Dolhain, 2019), these effects might not be drug-derived, but due to confounding by indication.…”

Section: Discussionmentioning

confidence: 94%

“…During reproductive age, rheumatoid arthritis (RA) is one of the most common chronic diseases. Female patients with RA have more difficulty conceiving a child, reflected by higher subfertility rates, longer time to pregnancy and decreased family size (Smeele and Dolhain, 2019). Subfertility, defined as a time to pregnancy of greater than 12 months, is related to disease activity in RA patients (Brouwer et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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IL-6 but Not TNFα Levels Are Associated With Time to Pregnancy in Female Rheumatoid Arthritis Patients With a Wish to Conceive

et al. 2020

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Fertility issues are common amongst women with rheumatoid arthritis (RA). Interleukin 6 (IL-6) and tumor necrosis factor alpha (TNFα), known key players in RA pathogenesis, have been associated with reproductive disorders. This study investigates the role of these cytokines in decreased fertility in women with active RA. Preconception cytokine measurements of 61 patients from the PARA-cohort, a prospective study on RA and pregnancy, were studied in relation to time to pregnancy as a measure for fertility. IL-6 levels were higher in patients with a time to pregnancy longer than 1 year (p = 0.016). Survival analysis of patients stratified by high or low serum IL-6 levels, shows a prolonged time to pregnancy in the high IL-6 group (p = 0.045). Univariate cox regression analysis of IL-6 in relation to time to pregnancy as well as multivariate cox regression analysis correcting for age, disease activity, nulliparity, NSAID use and prednisone use were performed, with hazards ratios for log transformed IL-6 of 0.68 (95% CI: 0.51–0.93, p = 0.015) and 0.66 (95% CI: 0.43–0.99, p = 0.044), respectively. For TNFα, no association with time to pregnancy was found. This study shows that high IL-6, but not TNFα, is associated with decreased fertility in women with RA. This finding provides a rationale to therapeutically target the IL-6 pathway in the time period before pregnancy. More research in the form of large cohort studies on drug safety and the effect of bDMARDS on fertility is needed for implementation of treatment strategies directed at fertility issues in women with RA.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

IL-6 but Not TNFα Levels Are Associated With Time to Pregnancy in Female Rheumatoid Arthritis Patients With a Wish to Conceive

et al. 2020

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“…Rheumatoid arthritis (RA) impairs fertility and pregnancy outcomes. 1 High disease activity in patients with RA is associated with a prolonged time to pregnancy 2 and is an independent risk factor for lower birth weight. 3 Over the last decades, the treatment of RA has evolved: early diagnosis, immediate initiation of disease-modifying antirheumatic drugs (DMARDs), several new approved drugs and a treat-to-target (T2T) approach aiming for remission have resulted in better outcomes for patients.…”

Section: Introductionmentioning

confidence: 99%

Modern treatment approach results in low disease activity in 90% of pregnant rheumatoid arthritis patients: the PreCARA study

et al. 2021

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ObjectivesIn patients with rheumatoid arthritis (RA), high disease activity impairs fertility outcomes and increases the risk of adverse pregnancy outcomes. The aim of this study was to determine the feasibility of a modern treatment approach, including treat-to-target (T2T) and the prescription of tumour necrosis factor (TNF) inhibitors, in patients with RA with a wish to conceive or who are pregnant.MethodsPatients were derived from the Preconception Counseling in Active RA (PreCARA) cohort. Patients with a wish to conceive or who are pregnant were treated according to a modified T2T approach, in which the obvious restrictions of pregnancy were taken into account. Results of the PreCARA study were compared with results of the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA) study, a historic reference cohort on RA during pregnancy. Patients in the PARA cohort were treated according to the standards of that time (2002–2010). Differences in disease activity over time between the two cohorts were tested using a linear mixed model.Results309 patients with RA were included in the PreCARA study, 188 children were born. 47.3% of the patients used a TNF inhibitor at any time during pregnancy. Mean disease activity over time in the PreCARA cohort was lower than in the reference cohort (p<0.001). In the PreCARA cohort, 75.4% of the patients were in low disease activity (LDA) or remission before pregnancy increasing to 90.4% in the third trimester, whereas in the PARA cohort, these percentages were 33.2% and 47.3%, respectively.ConclusionsThis first study on a modern treatment approach in pregnant patients with RA shows that LDA and remission are an attainable goal during pregnancy, with 90.4% of patients achieving this in the third trimester.

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“…Recent studies revealed that some immune-mediated inflammatory conditions, i.e., rheumatoid arthritis and inflammatory bowel diseases, especially in their active stages, can impact female fertility and pregnancy outcomes [8,9]. Thus, considering similar pathogenesis in autoimmune diseases, autoimmunity in psoriasis may be one of the causes of diminished ovarian reserve [10].…”

Section: Introductionmentioning

confidence: 99%

Effect of Excessive Body Weight and Psoriasis in Women Undergoing ICSI Procedure and State of Health of the Newborn

Wdowiak-Filip

Wdowiak

Raczkiewicz

et al. 2020

JCM

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Excessive body weight and some concomitant diseases, such as psoriasis, accompany women treated due to infertility by intracytoplasmic sperm injection (ICSI). This study is aimed to assess effect of obesity and psoriasis on quality of egg cells, embryos, course of pregnancy, and state of a newborn after treatment with ICSI. A total of 140 women were included into the study (110 healthy women and 30 with psoriasis). Among healthy women, BMI negatively correlated with total recovery rate, total oocyte score, blastocyst formation rate (BFR) and amount and quality of blastocysts (r < 0, p < 0.001). The relationships were similar in psoriasis, however apart from average blastocyst quality (p = 0.17) and BFR (p = 0.352). In healthy patients, BMI negatively correlated with gestational age at delivery (r = −0.444, p = 0.010) and APGAR (r = −0.481, p = 0.005). An excess of adipose tissue exerts an unfavourable effect on female reproductive functions, especially with a simultaneous burden of psoriasis. Excessive body weight is conducive to development of gestational diabetes and shortens the duration of pregnancy. The burden of psoriasis in combination with excessive body weight has an impact on the risk of occurrence of intrauterine growth restriction of foetus. Overweight and obesity negatively affect the state of a newborn, measured using APGAR scale.

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Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis

Cited by 35 publications

References 20 publications

IL-6 but Not TNFα Levels Are Associated With Time to Pregnancy in Female Rheumatoid Arthritis Patients With a Wish to Conceive

IL-6 but Not TNFα Levels Are Associated With Time to Pregnancy in Female Rheumatoid Arthritis Patients With a Wish to Conceive

Modern treatment approach results in low disease activity in 90% of pregnant rheumatoid arthritis patients: the PreCARA study

Effect of Excessive Body Weight and Psoriasis in Women Undergoing ICSI Procedure and State of Health of the Newborn

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