Pregnancy and neonatal outcomes in women with axial spondyloarthritis: pooled data analysis from the European Network of Pregnancy Registries in Rheumatology (EuNeP)

Abstract

ObjectiveTo investigate outcome and course of pregnancies in women with axial spondyloarthritis (axSpA) in a pooled data analysis of pregnancy registries in rheumatology.MethodsProspectively followed women with axSpA, fulfilling ASAS classification criteria and for whom a pregnancy outcome was reported, were eligible for the analysis. Anonymised data of four registries was pooled. Rates of adverse pregnancy outcomes were calculated. Systemic inflammation, disease activity and treatment patterns with tumour necrosis factor inhibitor (TNFi) before, during and after pregnancy were analysed.ResultsIn a total of 332 pregnancies from 304 axSpA women, 98.8% of the pregnancies resulted in live birth. Mean maternal age was 31 years and disease duration 5 years. Most of these patients received pre-conception counselling (78.4%). Before pregnancy, 53% received TNFi treatment, 27.5% in first and 21.4% in third trimester. Pregnancy and neonatal outcomes were favourable with rates of 2.2% for pre-eclampsia, 4.9% for preterm birth, 3.1% for low birth weight and 9.5% for small for gestational age. Neonates were delivered by caesarean section in 27.7% of pregnancies, of which 47.4% were emergencies. Pooled mean CRP was 4 mg/L before conception peaking in the second trimester at 9.4 mg/L. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was below 4 at all time-points.ConclusionsPooled rates of most outcomes were better than what had been reported in the literature and within expected rates of those reported for the general population. Pre-conception counselling, planned pregnancies and a tight management in expert centres applying a tailored treatment approach may have contributed to the favourable pregnancy outcomes.

Risk of pre-eclampsia and impact of disease activity and antirheumatic treatment in women with rheumatoid arthritis, axial spondylarthritis and psoriatic arthritis: a collaborative matched cohort study from Sweden and Denmark

“…Hence, to obtain more granular information, a prospective study with a close follow-up of women included before or in early pregnancy would be optimal. 48 …”

“…Hence, to obtain more granular information, a prospective study with a close follow-up of women included before or in early pregnancy would be optimal. 48 With respect to AxSpA, both patients with ankylosing spondylitis and unspecific spondyloarthritis were included without stratifying on subtypes, and we lacked more valid measures of disease activity, such as BASDAI. 47 Despite extensive confounder adjustment, we could not eliminate potential residual confounding due to the observational study design.…”

“…The relatively large proportion of patients without visits during pregnancy in the quality registers suggests that the clinical practice of patient follow-up during pregnancy, in some perspectives, is suboptimal. Hence, to obtain more granular information, a prospective study with a close follow-up of women included before or in early pregnancy would be optimal 48…”

Challenges in Family Planning and Pregnancy for Women with Rheumatic Diseases

“…97,98 PsA has been associated with an increased risk of gestational hypertension and SGA, 9 and axial SpA has been associated with increased C-section rates. 8,10 Women with PsA and SpA may experience disease activity during or after pregnancy, although this is generally mild. 99,100 Use of tumour necrosis factor inhibitors (TNFis) during pregnancy in these groups has been associated with decreased disease activity, 99 and discontinuation of TNFis upon conception has been associated with increased disease activity.…”

“…Disease activity may improve during pregnancy for some women with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthritis (SpA), but inflammatory arthritis may also be associated with increased risk of APOs, including preterm and caesarean delivery (C-section). [7][8][9][10][11] Research that informs family planning and pregnancy considerations in women with other RDs is more limited. In general, achieving disease quiescence using pregnancy-compatible medications prior to conception improves maternal and foetal outcomes regardless of the underlying RD.…”