Factors Associated With Time to Pregnancy in Women With Axial Spondyloarthritis: A Registry‐Based Multicenter Study

Abstract

Objective. The present study was undertaken to study time to pregnancy (TTP) and factors associated with TTP in women with axial spondyloarthritis (SpA) compared to women with rheumatoid arthritis (RA).Methods. We included 274 women with axial SpA and 317 women with RA from the Norwegian nationwide registry RevNatus. For all the women, we had retrospectively collected data on TTP, and a subgroup also had prospectively collected data. We compared TTP in women with axial SpA to women with RA using Kaplan-Meier plots and a log rank test. To identify factors associated with TTP, we used Cox proportional hazards regression.Results. TTP exceeded 12 months in 21% of women with axial SpA. In the subgroup followed prospectively, 32% had TTP that exceeded 12 months. Longer TTP was associated with older age, nulliparity, and longer disease duration, with hazard ratios of 0.97 (95% confidence interval [95% CI] 0.94-1.00), 0.66 (95% CI 0.50-0.88), and 0.94 (95% CI 0.91-0.98), respectively. Disease activity, medication, and self-reported health-related quality of life were not associated with TTP. We found no statistically significant differences between axial SpA and RA in regard to TTP. Conclusion.In women with axial SpA, longer TTP was associated with older age, nulliparity, and longer disease duration.

NSAID exposure delays time-to-pregnancy in patients with spondyloarthritis: an analysis of the GR2 prospective cohort

“…More recently, the Norwegian RevNatus registry showed that TTP exceeded 12 months (the threshold for defining ‘infertility’) in 21% of 274 women with SpA followed up between 2006 and 2018. In this cohort, longer TTP was associated with older age, nulliparity and longer disease duration 21…”

“…Only one recent study has specifically investigated TTP in women with SpA 21. It included 274 women with axSpA and found a median TTP of 2 months, with 21.2% of the women subfertile.…”

Pregnancy outcomes in patients with axial spondyloarthritis: a UK-based survey

“…More recently, one nationwide study in France, utilising a current-duration approach, found that 24% of women 18–44 years of age and trying to conceive did not achieve a TTP within 12 months [ 11 ]. For women with axSpA and SpA, the proportion of women exceeding a TTP of 12 months has been reported as 21.1% in a Norwegian registry-based multicentre study [ 12 ] and 45.4% in a French multicentre prospective observational study [ 13 ]. It appears that a TTP >12 months is common in women with axSpA; however, a complex range of factors (such as age, lifestyle, gynaecological conditions and medication use) likely contribute to this delay.…”

“…It appears that a TTP >12 months is common in women with axSpA; however, a complex range of factors (such as age, lifestyle, gynaecological conditions and medication use) likely contribute to this delay. For example, longer TTP has been associated with older age, longer disease activity, nulliparity [ 12 ] and NSAID use during preconception [ 13 ]. In the current study, NSAID use during the preconception period was reported for 40.0% of pregnancies with a TTP >12 months.…”

Fertility issues in women of childbearing age with spondyloarthritis

“…In the comparison between RA and SpA women, subfertility was found to be more common in the former. The “PARA study” assessed the TTP in RA women and found a TTP >12 months in 42% of the 245 patients analysed ( 42 ), a higher proportion than that observed in the Norwegian cohort of SpA ( 39 ). The factors related to a prolonged TTP were older age, nulliparity, high disease activity (measured through DAS-28), and the pre-conceptional use of NSAIDs and prednisone >7.5 mg/day.…”