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BackgroundWomen with inflammatory arthropaties (IA) have fertility problems and complications during pregnancy and frequently biological therapy (BT) is required for the disease control.ObjectivesTo evaluate pregnancy in women with IA in a multidisciplinary unit composed of Rheumatologists and Obstetricians: describe disease evolution, complications and treatment.MethodsRetrospective and descriptive study of the evolution of pregnancy in patients with IA [Rheumatoid Arthritis (RA), Spondyloarthritis (SpA), Psoriatic arthritis (PsA) and Juvenile Idiopathic Arthritis (JIA)] and follow-up in a multidisciplinary unit for more than 15 years (until December 2021). Demographics, maternal disease, time until conception, previous abortions and presence of antibodies were collected. In addition, during follow-up, treatment, abortions, cesarean sections (C-section), preterm births, disease activity and maternal/fetal complications were collected.ResultsWe registered 49 pregnancies (39 women): 27 RA (55.1%), 9 SpA (18.4%), 9 PsA (18.4%) and 4 JIA (8.1%). Maternal average age at diagnosis was 26.8±6.7 years and average age at childbirth/abortion was 34.5±5.3 years.It took an average time of 9±7.7 months to conceive. 8.2% received fertility treatment with in vitro fertilization techniques.AntiRo antibodies were registered in 6.3% of patients and 28.6% had at least 1 antiphospholipid antibody.At the time of gestational desire/gestation 24 women (13 RA, 5 SpA, 3 PsA, 3 JIA) were receiving BT: 14 certolizumab (CZP), 5 adalimumab (ADA), 4 etanercept (ETN). 1 patient was being treated with baricitinib (BARI). Due to pregnancy, ADA was changed to CZP in 3 women and BT was stopped in 6 cases (3 ETN, 2 ADA, 1 CZP) as well as BARI. In 2 cases, ADA was stopped at week 17 of pregnancy (medical indication). Pregnancy was completed with BT (CZP) in 15 cases.9 abortions were registered prior to follow-up in the unit (0.23 abortions/mother) and 3 (2 RA, 1 PsA) during follow-up (0.07 abortions/mother): 2 (1 RA, 1 PsA) of them in women with CZP. RA patient had positive antiphospholipid antibodies and was a smoker and the other one had moderate disease activity by the time of the abortion. C-section was performed in 26.1% of cases. Preterm birth (A total of 19 different fetal/maternal complications were registered during follow-up: 8 in the BT group (42.1%) compared to 11 (57.9%) in the group without BT, being Intrauterine Growth Restriction (IUGR) more frequent among women with BT. Infections were not more common in patients with BT. Table 1.Table 1.COMPLICATIONSWITH BT (n, %) n: 17WITHOUT BT (n, %) n: 32IUGR3 (17.6)1 (3.1)LBW2 (11.8)2 (6.2)INFECTION1 (5.9)4 (12.5)CHOLESTASIS0 (0)2 (6.2)PREECLAMPSIA0 (0)1 (3.1)DM2 (11.8)1 (3.1)HIGH BLOOD PRESSURE0 (0)0 (0)NEPHROPATY0 (0)0 (0)NEONATAL LUPUS0 (0)0 (0)HEART BLOCK0 (0)0 (0)MALFORMATION0 (0)0 (0)HELLP SYNDROME0 (0)0 (0)TOTAL811Regarding concomitant treatment, low dose prednisone was used in 32.7% of pregnancies, hydroxychloroquine in 44.9%, sulfasalazine in 8.2% and acetylsalicylic acid in 51%. We didn´t find differences in the use of these treatments between the two groups.Median DAS28 among RA patients with available data was under 2.6 throughout pregnancy as well as previously and posteriorly. No differences in median DAS28 were found between women with BT and without BT. SpA patients had BASDAI lower than 4 in both groups during pregnancy and previously.ConclusionIn our series, as described in the literature, women with IA are older and more likely to have preterm births compared to general population. Appropriate disease control was maintained during pregnancy, also previously and afterwards. We registered more IUGR, low birth weight (LBW) and diabetes mellitus (DM) among women with BT but lower rate of infections. Given the low number of patients with BT no statistically significant conclusions about complications can be drawn. Therefore, more studies among pregnant women with BT are necessary.Disclosure of InterestsNone declared

Background Pregnancies in women with inflammatory and autoimmune diseases are considered high-risk pregnancies, so close and ideally multidisciplinary control is necessary. Given the advances in treatment and identification of risk factors a higher percentage of patients manifest gestational desire. Objectives To describe our experience in a multidisciplinary unit (integrated by Rheumatologists and Obstetrics) and assess the complications in the evolution of pregnancies and treatments used in patients with inflammatory and autoimmune diseases. Methods Retrospective study of pregnancy outcome in patients with rheumatic diseases and follow-up in a multidisciplinary unit for 15 years (January 2003-December 2018). Demographic characteristics, maternal disease, comorbidities, previous abortions, presence of autoantibodies (AAb), number of births, fetal losses and abortions during follow-up, previous treatment and treatment during pregnancy and maternal and fetal complications were collected. Frequencies and percentages were used in qualitative variables, mean±SD in quantitative and for the comparison between groups Chi2 test (or Fisher test if appropriate) was used in categorical variables and Student T test (or U of Mann-Whitney if appropriate) in quantitative variables. Data was analysed using IBM SPSS v23. Results 141 patients (194 pregnancies) were registered with maternal average age at rheumatic disease diagnosis of 29.14 ± 6.6 years and average age at abortion/childbirth of 34.82 ± 4.63 years. 12.8% were smokers and 21.1% had comorbidity (hypothyroidism:10.8%, dyslipidemia:2.1%). Maternal diseases are collected in table 1. 50 abortions were registered prior to follow-up in our unit (0.35 abortions/mother). During follow-up 19 abortions were registered (0.13 abortions/mother). Frequencies of abortions/births are specified in table 1. 13.5% of pregnancies were pre-term ( The frequency of different AAb is found in table 2. Anti-Ro carriers (36.6%) did not have higher frequency of abortions (p = 0,798) and only one case of heart block was recorded among them. Abortions were more frequent among women with positive antiphospholipid antibodies (14.3% compared to 4.3%) (p = 0,013). In inflammatory diseases (PsA, RA, spondyloarthropathies) no abortions were registered. Intrauterine growth restriction (IUGR) was observed in 7 cases (3.7%) and pre-eclampsia in 6 (3%) being more frequent among patients with SLE (n:3 and n:2 respectively), APS (n:1 and n:1) and asymptomatic women with positive autoantibodies (n:2 and n:1). No difference was observed in complications rate between anti-Ro positive and anti-Ro negative women (p = 0.047). Treatments used prior to and during pregnancy are shown in table 3. Conclusion In our series, as previously described in the literature, women with systemic autoimmune and inflammatory diseases have higher risk of abortion, pregnancy complications and instrumental delivery than general population. SLE and APS are most associated with these complications. Multidisciplinary close follow-up of these patients improves pregnancy outcomes. References [1] - Pregnancy and reproduction in autoimmune rheumatic diseases. M. Ostenses, et al. Rheumatology, Volume 50, Issue 4, 1 April 2011, Pages 657-664 [2] - State of the art: Reproduction and pregnancy in Rheumatic diseases. M. Ostenses. Autoimmunity Reviews. Volume 14, Issue 5, May 2015, Pages 376-386. Disclosure of Interests None declared

Background:Women with inflammatory arthropaties have fertility problems and complications during pregnancy and frequently biological therapy (BT) is required for the disease control.Objectives:To evaluate pregnancy in women with inflammatory arthropaties in a multidisciplinary unit composed of Rheumatologists and Obstetricians: describe disease evolution, complications and treatment used (including BT).Methods:Retrospective and descriptive study of the evolution of pregnancy in patients withinflammatory diseases (Rheumatoid Arthritis (RA), Spondyloarthritis (SpA) and Juvenile Idiopathic Arthritis (JIA)) and follow-up in a multidisciplinary unit for more than 15 years (until December 2020). Demographics, maternal disease, time until conception, previous abortions and presence of antibodies were collected. In addition, during follow-up, treatment, abortions, Caesarean sections (C-section), preterm births, disease activity and maternal/fetal complications were collected.Results:We registered 41 pregnancies (32 women): 20 RA (62.5%), 9 SpA (28.1%) and 3 JIA (9.4%). Maternal average age at diagnosis was 27.1±6.6 years and average age at childbirth/abortion was 34.9±5.1 years.It took an average time of 9.6±8.5 months to conceive. 9.8% received fertility treatment with in vitro fertilization techniques.AntiRo antibodies were registered in 7.3% of patients and 34.1% had at least 1 antiphospholipid antibody.At the time of gestational desire/gestation 17 women (12 RA, 4 SpA, 2 JIA) were receiving BT: 7 certolizumab (CZP), 7 adalimumab (ADA), 3 etanercept (ETN). 1 patient was being treated with baricitinib. Due to pregnancy, ADA was changed to CZP in 3 women and BT was stopped in 6 cases (3 ETN, 2 ADA, 1 CZP) as well as baricitinib. In 2 cases, ADA was stopped at week 17 of pregnancy (medical indication). Pregnancy was completed with BT (CZP) in 9 cases.9 abortions were registered prior to follow-up in the unit (0.28 abortions/mother) and 3 during follow-up (0.09 abortions/mother): 2 of them in women with CZP.C-section was performed in 26.8% of cases.Preterm birth (A total of 17 different fetal/maternal complications were registered during follow-up: 6 in the BT group (35.3%) compared to 11 (64.7%) in the group without BT, being Intrauterine Growth Restriction (IUGR) more frequent among women with BT. Infections were not more common in patients with BT. Complications are listed in Table 1.Table 1.COMPLICATIONSWITH BT (n, %) n: 11WITHOUT BT (n, %) n: 30IUGR3 (27.3%)1 (3.3%)LOW BIRTH WEIGHT2 (18.2%)2 (6.6%)INFECTION1 (9.1%)4 (13.3%)CHOLESTASIS0 (0%)2 (6.6%)PREECLAMPSIA0 (0%)1 (3.3%)DIABETES MELLITUS0 (0%)1 (3.3%)HIGH BLOOD PRESSURE0 (0%)0 (0%)NEPHROPATY0 (0%)0 (0%)NEONATAL LUPUS0 (0%)0 (0%)HEART BLOCK (0%)0 (0%)MALFORMATION0 (0%)0 (0%)HELLP SYNDROME0/0%)0 (0%)TOTAL6 (54.6%)11 (36.4%)Regarding concomitant treatment, low dose prednisone was used in 48.8% of pregnancies, hydroxychloroquine in 51.2%, sulfasalazine in 9.8% and acetylsalicylic acid in 51.2%. We didn´t find differences in the use of these treatments between the two groups.Median DAS28 among RA patients and available data was under 2.6 throughout pregnancy as well as previously and posteriorly. No differences in median DAS28 were found between women with BT and without BT. SpA patients had BASDAI lower than 4 in both groups during pregnancy and previously.Conclusion:In our series, as described in the literature, women with inflammatory arthropaties are older and are more likely to have preterm births compared to general population. Fewer abortions were registered during follow-up in the multidisciplinary unit. Appropriate disease control was maintained during pregnancy, also previously and afterwards. We registered more IUGR and low birth weight among women with BT but given the low number of patients with BT no statistically significant conclusions about complications can be drawn. Therefore, more studies among pregnant women with BT are necessary.Disclosure of Interests:None declared

Background:Systemic inflammatory diseases are common in women at the reproductive age. These women may have fertility problems and complications during pregnancy.Objectives:To describe the experience in a multidisciplinary unit (composed of Rheumatologists and Obstetricians) and asses the complications and treatments used in patients with inflammatory diseases in a tertiary hospital compared to those registered in healthy women from the same center (preterm births 6.59%, Caesarean section (C-section) 14.4%, maternal average age 33.33 years).Methods:Retrospective and descriptive study of the evolution of pregnancy in patients with inflammatory diseases and follow-up in a multidisciplinary unit for more than 15 years (until December 2019). Demographics, maternal disease, time until conception, births, abortions, C-sections, treatments and complications were collected. Data was analyzed using IBM SPSS v23.Results:We registered 29 pregnancies (25 patients): 20 Rheumatoid Arthritis (RA), 5 Psoriatic Arthritis (PsA), and 4 Spondylarthritis (SpA). Maternal average age at diagnosis was 27.6±6.36 years and average age at childbirth/abortion 35±5.6 years.It took an average time of 8 months to conceive. 11.5% received fertility treatment using in vitro fertilization techniques.5 abortions were registered prior to follow-up in this unit (0.2 abortions/mother). During follow-up 1 abortion (0.04 abortions/mother) was recorded in a RA patient. C-section was performed in 11 cases (39.2%): 6 RA (31.6%), 3 SpA (75%) and 2 PsA (40%).17.2% of pregnancies were preterm (Intrauterine growth restriction (IUGR) was observed in a woman (3.4%) with RA and preeclampsia was observed in 2 cases (6.9%) (RA 1, SpA 1).Disease activity (DAS28 and BASDAI) is shown in Table 1.Table 1.DAS28 (median)PreviousFirstTrimesterSecondTrimesterThirdTrimesterPosteriorRheumatoid Arthritis2.692.593.093.333.11Psoriatic Arthritis2.582.53.323.082.89RA with biological agents (n: 6)2.372.942.712.42.52BASDAI (median)Spondylarthritis2.82.41.7511.9Treatments used prior to and during pregnancy are listed in Table 2.Table 2.TREATMENT BEFORE PREGNANCYn (%)TREATMENT DURINGPREGNANCYn (%)Hydroxychloroquine13 (44.8%)Prednisone17 (58.6%)Prednisone12 (41.4%)Acetylsalicylic acid16 (55.2%)Methotrexate9 (31%)Hydroxychloroquine15 (51.7%)TNF inhibitors7 (24.1%)Sulfasalazine2 (6.9%)Sulfasalazine2 (6.9%)TNF inhibitors2 (6.9%)8 patients had received biological treatment prior to pregnancy (2 SpA, 6 RA)(3 Etanercept, 3 Adalimumab, 2 Certolizumab). 2 of them (RA) continued treatment during pregnancy. 1 of them discontinued it at week 17 on her own (Adalimumab) while the other continued with Certolizumab throughout pregnancy and presented IUGR. No other complications, such as infections or malformation, were observed in newborns. DAS28 data of these women can be found in Table 1.Conclusion:In our series, as described in the literature, women with inflammatory arthropaties are older, need longer time to achieve pregnancy and have increased use of fertility techniques and increased likelihood of preterm and instrumental delivery compared to general population. Given the low number of patients receiving biological treatment no conclusions about complications and evolution of the disease can be drawn, so further investigation are needed in this group of patients.Monitoring inflammatory arthropathies in a multidisciplinary unit increases the chances of successful pregnancies.Disclosure of Interests:None declared