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

Objective: To investigate outcome and course of pregnancies in women with axial spondyloarthritis (axSpA) in a pooled data analysis of pregnancy registries in rheumatology.
Methods: Prospectively 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.
Results: In 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.
Conclusions: Pooled 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.
Competing Interests: Competing interests: YM: lecture honoraria from Pfizer outside the scope of the submitted work. AS: speaker fees from AbbVie, Amgen, BMS, Celltrion, Janssen, Lilly, Pfizer, Roche, Sanofi, UCB. AM: consulting fees and symposia: AbbVie, BMS, Janssen, MSD, Pfizer, Biogen, Galapagos, Lilly; research grants: UCB France and Pfizer. FF: Grant/research support from UCB Pharma and GSK; speakers bureau for Mepha, Roche and UCB Pharma. The GR2 study has received grants from patient associations (Lupus France; association des Sclérodermiques de France, association Gougerot Sjögren, AFPCA - Association Francophone contre la Polychondrite chronique atrophiante), from the AFM-Telethon, the French Society of Internal Medicine (SNFMI), the French Society of Rheumatology (SFR), the CMEL commission for Research and Innovation of Cochin Hospital, the Ministère de la Santé (the Clinical REsearch Contract – Database CRCBDD17003), FOREUM (Foundation for Research in Rheumatology), ORRICK society (Price Véronique ROUALET) and an unrestricted grant from UCB (the company had no role in the initiation, planning, conduct, data assembly, analysis or interpretation of the study). IH: consulting fees and symposia: Boehringer Ingelheim, Lilly. CR: consulting fees and symposia: AbbVie, Amgen, Astra Zeneca, BMS, Celltrion, GSK, MSD, Novartis, Pfizer, Biogen, Galapagos, Lilly; research grants: Biogen and Lilly. JS: consulting fees and symposia: AbbVie, BMS, Janssen, MSD, Pfizer, Roche, Sandoz, Fresenius Kabi, Galapagos, Lilly; research grants: Roche France, MSD and Pfizer. The remaining authors have no conflicts of interest to declare.
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