medwireNews: Findings from a systematic review and meta-analysis suggest that spondyloarthritis (SpA) is associated with an elevated risk for adverse pregnancy outcomes, including preterm birth and preeclampsia.
“These results strongly argue in favor of a multidisciplinary management approach for women with SpA and a pregnancy desire,” say Sabrina Hamroun (Cochin Hospital, Paris, France) and team in Rheumatology.
They identified 21 studies, involving 3566 patients with axial (ax)SpA (79.9%) or psoriatic arthritis (PsA; 20.1%), 12 of which included 42,264 controls. There were 3718 pregnancies among patients and 55,459 among controls.
Meta-analysis of nine studies with data for pregnancy outcomes showed that women with axSpA or PsA were significantly more likely than controls to have a preterm birth or cesarean section, at odds ratios (ORs) of 1.61 and 1.70, respectively.
Among patients with axSpA, the risk for both elective and emergency cesarean sections was significantly higher than for controls (ORs=2.64 and 1.53, respectively), but among patients with PsA, there was a significant increase in the incidence of elective cesarean sections only (OR=1.47).
axSpA was also significantly associated with an increased risk for small for gestational age babies and preeclampsia (ORs=2.05 and 1.59, respectively), but no such associations were seen for PsA.
Analysis of studies with data on disease activity in patients with axSpA (n=12 studies) or PsA (n=7) showed “a tendency for unchanged or worsened disease activity in axSpA and unchanged or improved disease activity in PsA” during pregnancy, say Hamroun and colleagues.
The proportion of axSpA patients who experienced a worsening of disease activity during pregnancy ranged from 0% to 62% across the studies, with only one case–control study showing an improvement in disease activity. By comparison, just 15–22% of patients with PsA had worsening disease activity during pregnancy, while two prospective studies found an improvement.
Meanwhile, in the postpartum period 22–92% and 21–100% of patients in the axSpA and PsA groups, respectively, experienced a worsening of disease activity.
Hamroun et al also set out to investigate the association between SpA and fertility, but were unable to identify a clear association. They note that only four of the 21 studies reported information on fertility, and all had a high risk for bias, which “confirms the virtual lack of data on fertility during SpA,” and “emphasizes the need for prospective studies focusing on the pre-conceptional period.”
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