medwireNews: Women with axial spondyloarthritis (axSpA) have “very low” rates of adverse pregnancy outcomes, show observational data from European pregnancy registries.
The incidence of outcomes such as pre-eclampsia, preterm birth, and low birthweight “were comparable with the general population and lower than rates reported from other axSpA populations,” write Yvette Meissner (Deutsches Rheuma-Forschungszentrum Berlin, Germany) and co-investigators in the Annals of the Rheumatic Diseases.
They add that the study “investigated rather recent pregnancies, with most deliveries occurring from 2015 onwards, which might reflect both the wider use of very effective treatments (eg, biologics) and also the increased knowledge about pregnancies in this patient group and therefore changed rheumatology and obstetric routines.”
Meissner and team reviewed information on women with axSpA prospectively collected by pregnancy registries in France, Germany, Norway, and Switzerland before, during and after pregnancy.
In total, there were 332 pregnancies among 304 women with axSpA (mean age 31 years, mean duration 5 years) between 2008 and 2020, with 93.6% of pregnancies recorded in 2015 onward. Of these, 98.8% resulted in live births. The four pregnancies that resulted in miscarriage or still birth were excluded from the analyses.
The researchers report that the majority (86.5%) of pregnancies were planned and most (78.4%) received rheumatology counselling prior to conception. They describe the pregnancy and neonatal outcomes as “favourable.”
Neonates were delivered at 39 weeks on average, with 4.9% of pregnancies ending in premature delivery. Overall, 27.7% of pregnancies required a cesarean section delivery, of which 47.4% were emergencies.
The pooled pre-eclampsia rate was 2.2%, which was comparable to the rates of 2.2–4.0% reported in the general population. The preterm birth rate of 4.9% was lower than that reported for the European general population, at 8.7%.
The proportion of neonates with low birthweight (3.1%) was also lower than the European average (7.0%), while the incidence of babies born small for gestational age (SGA; 9.5%) was similar to the expected rate of 10%.
Increased birthweight, ie, macrosomia or large for gestational age (LGA), occurred in 10.7% of the neonates.
Inflammation levels among the women peaked during the second trimester with mean C-reactive protein levels increasing to 9.4 mg/mL from a baseline of 4.0 mg/mL. By comparison, disease activity was stable throughout pregnancy, reflected in mean BASDAI scores that were below 4.0 at all timepoints.
In just over half (52.6%) of the pregnancies, the women received a tumor necrosis factor (TNF) inhibitor before conception, while around a third (32.7%) were given the drug at any time between conception and delivery. In 17.8% of pregnancies, a TNF inhibitor was given in all three trimesters, while in 8.9% the treatment was provided in either the first or first and second trimesters.
The researchers note that delivery mode and SGA rates were similar regardless of TNF inhibitor treatment, but rates of pre-eclampsia, preterm birth, and LGA were lower among the women who did versus did not receive the treatment.
Meissner et al conclude: “Our findings underline the importance of pre-conception counselling, pregnancy planning and tight monitoring aiming at low disease activity or remission and assume that they contribute to achieve good pregnancy outcomes in women with axSpA.”
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