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05-09-2019 | Juvenile idiopathic arthritis | News

Pregnancy outcomes largely unaffected by DMARD exposure at conception in JIA

medwireNews: Juvenile idiopathic arthritis (JIA) patients taking DMARDs at the time they conceive do not have an increased risk for major adverse pregnancy outcomes, research suggests.

The investigators also note that “[d]isease activity during pregnancy remained relatively stable in JIA patients, although DMARDs were mostly discontinued.”

They analyzed data on 191 pregnancies ─ of 98 women with JIA and the partners of 21 men with JIA ─ from the Biologics in Paediatric Rheumatology registry and its follow-up registry Juvenile arthritis Methotrexate/Biologics long-term Observation. 

Both female and male patients were observed for about 8 years prior to conception, during which time there were a respective 67 and 26 pregnancies exposed to DMARDs.

The researchers note that DMARD treatment was terminated in most women with JIA within 11.5 weeks of conception.

Pregnancies among the female JIA patients resulted in live births in 106 cases and the only significant difference in outcomes between the DMARD-exposed and non-exposed groups was the rate of hemorrhage, which was reduced in the former group (2.5 vs 12.1%).

There was no significant difference in other pregnancy complications, such as pre-eclampsia or gestational hypertension, nor in adverse neonatal outcomes, such as babies being small for gestational age, neonatal infection, or death.

This remained the case even after taking into account different types of DMARDs, disease activity, and JIA categories.

And there were no significant differences in pregnancy outcomes among the partners of men with JIA who were exposed or not exposed to DMARDs.

The team did find, however, that the rate of elective termination was significantly higher among women who took DMARDs than among those who did not, at 25.4% versus 5.9%.

“Notably, approximately every fifth DMARD-exposed pregnancy was electively terminated, including every fourth pregnancy in DMARD-exposed women and every second pregnancy in [methotrexate]- or [leflunomide]-exposed women,” say Kristen Minden (German Rheumatism Research Center, Berlin) and study co-authors in Rheumatology.

They do acknowledge, however, that “the young patient age and the high rate of unplanned pregnancies [over half] among those exposed may have contributed to the high rate of elective terminations.”

The main reason women elected to terminate a pregnancy was because of the fear of malformation. Yet in the current study the rate was just 5.8% among all 138 live births, of which 3.6% were major ─ a rate that is comparable to that of the general population.

“These findings underline the importance of addressing family planning in rheumatological practice and the need for adequate information and counselling of young people with rheumatic diseases on drug safety at conception and pregnancy,” say the researchers.

DMARD exposure was also associated with a slight, albeit not statistically significant, increase in the rates of preterm births (15.0 vs 10.6%) and underweight newborns (7.5 vs 3.0%), but the researchers note that, irrespective of treatment, rates of preterm birth were higher for women with JIA compared with the general population. This was also true for cesarean section rates.

“As DMARD-exposed women had a higher disease activity than unexposed women, in addition to drug exposure, active disease must also be considered a risk factor for unfavourable pregnancy outcomes,” they comment.

Overall, Minden and co-authors conclude that “despite long-term and often intrapregnancy exposure to DMARDs, most pregnancy outcomes were within the range expected for the general population,” while emphasizing that “more information on the use of DMARDs in both women and men during the conception period is needed.”

By Hannah Kitt

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Rheumatology (Oxford) 2019; doi:10.1093/rheumatology/kez309

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