Fertility and pregnancy outcomes in women with spondyloarthritis: a systematic review and meta-analysis

Abstract

Objective To determine the impact of spondyloarthritis (SpA) and its treatments on fertility and pregnancy outcomes, as well as the impact of pregnancy on disease activity. Methods A systematic review and meta-analyses were performed, including studies in women with SpA (axial (axSpA) and peripheral SpA, including psoriatic arthritis (PsA)). The heterogeneity between studies was quantified (I2), and in case of substantial heterogeneity, the results were reported in a narrative review. Results Within 4397 eligible studies, 21 articles were included, assessing overall 3566 patients and 3718 pregnancies compared to 42264 controls. Fertility suffers from a lack of data in the literature. We found an increased risk of preterm birth (pooled OR 1,64 [1,15-2,33], I2 =24% in axSpA and 1,62 [1,23-2,15], I2 =0,0% in PsA), small for gestational age (pooled OR 2,05, [1,09-3,89], I2 =5,8% in axSpA), preeclampsia (pooled OR 1,59, [1,11-2,27], I2 =0% in axSpA) and caesarean section (pooled OR 1,70 [1,44-2,00], I2 =19,9% in axSpA and 1,71 [1,14-2,55], I2 =74,3% in PsA), without any other unfavourable pregnancy outcome. Further analysis showed a significant higher risk for elective caesarean (pooled OR 2,64, [1,92-3,62], I2 =0,0% in axSpA and 1,47, [1,15-1,88], I2 =0,0% in PsA), without increased risk for emergency caesarean in PsA. During pregnancy, there appears to be a tendency for unchanged or worsened disease activity in axSpA and unchanged or improved disease activity in PsA. Both conditions tend to flare in postpartum period. Conclusion SpA seems to be associated with an increased risk of preterm birth, small for gestational age, preeclampsia, and caesarean section.

Maternal and infant outcomes in pregnancies of women with axial spondyloarthritis compared with matched controls: results from nationwide health insurance data

“…Furthermore, the proportion of stillbirths in women with axSpA was comparable with controls (0.5% vs 0.4%), which is in line with national statistics (0.4% 13 ) and was also reported in the latest reviews and meta-analyses. [2][3][4] There was also no difference observed for gestational diabetes, consistent with previous results. [2][3][4] Altogether congenital malformations were comparable between infants from axSpA pregnancies (8.5%) and from control pregnancies (9.0%).…”

“…[2][3][4] There was also no difference observed for gestational diabetes, consistent with previous results. [2][3][4] Altogether congenital malformations were comparable between infants from axSpA pregnancies (8.5%) and from control pregnancies (9.0%). These proportions are higher than the 6.5% reported in literature, 17 which is likely due to our less restrictive adaptation of the classification criteria of EUROCAT.…”

“…Our study confirms one of the main findings of latest reviews and meta-analyses regarding the increased odds of CS. [2][3][4] Both elective and emergency CS were more common in women with axSpA than in controls. However, our explanatory analyses by treatment group showed that the risk of emergency CS in comparison with controls was only increased in women with axSpA under treatment with bDMARDs, who were more likely than controls to deliver by emergency CS.…”

“…Despite the increased number of studies published in the past decade, the latest literature reviews and metaanalyses highlight the dire need for further research on the outcomes of pregnancy in axSpA due to the large heterogeneity among present studies. [2][3][4] Moreover, it is pointed out that large cohorts of women with axSpA are required and a special focus should be on pharmacological treatment during pregnancy.…”

“…In recent years, interest in pregnancy outcomes in axial spondyloarthritis (axSpA), a chronic inflammatory rheumatic disease that predominantly affects the spine and/ or sacroiliac joints, 1 has increased as demonstrated by the latest literature reviews and meta-analyses. [2][3][4][5] One of their main results is the increased prevalence of caesarean sections (CSs) compared with the general population. Preterm birth also showed a significant trend towards increased prevalence in axSpA pregnancies.…”