Adverse Pregnancy Outcomes Rise with Active PsA/AS Disease and Corticosteroid Use

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Pregnant women with psoriatic arthritis and ankylosing spondylitis with active disease or who are using corticosteroids are at an increased risk for adverse pregnancy outcomes, according to new research.

Published in a recent Arthritis Care & Research issue, the study revealed, while women with psoriasis arthritis and ankylosing spondylitis have overall favorable pregnancy outcomes, preterm birth, preterm labor, and Caesarian deliveries are more common if they have active disease.

“Unfortunately, data is lacking on pregnancy outcomes, often making it difficult for rheumatologists and obstetricians to counsel their patients effectively,” said study author Chelsey Smith, M.D., a rheumatologist affiliated with Cedars-Sinai Medical Center. “The goal of our prospective cohort trial is to add to the very limited amount of robust data on pregnancy outcomes and disease activity in these two chronic inflammatory diseases.”

To determine the effect of these conditions, researchers analyzed pregnancy outcomes on 963 women - 117 with psoriatic arthritis, 129 with ankylosing spondylitis, and 717 in a comparison group. Women in both disease groups experienced more co-morbid conditions, including asthma, diabetes, hypertension, depression, and anxiety.

Based on study results, women with active psoriatic arthritis later in pregnancy were at an increased risk for moderate preterm delivery between 32 and 37 weeks, preterm labor, low amniotic fluid, and Caesarian delivery. However, investigators said, the reasons behind the increased risk for low amniotic fluid and Caesarian delivery remain unclear.

The greatest threat to women with ankylosing spondylitis was a 67-percent increased risk for infant hospitalization in the neonatal intensive care unit. In addition, women with high disease activity were also at an increased risk for Caesarian delivery, although, as with the psoriatic arthritis group, the reason isn’t clear.

And, despite American College of Rheumatology recommendations against it, investigators identified high systemic corticosteroid use among women with ankylosing spondylitis. Study findings revealed use in the second trimester was associated with an increased preterm delivery risk. Due to this risk, researchers suggested considering alternative medications first when clinically appropriate.

Overall, they said, additional investigations are needed to further understand how medication use and different disease measures affect pregnancy outcomes in these two conditions.

REFERENCE

Smith C, Bandoli G, Kavanaugh A, Chambers C, Birth Outcomes and Disease Activity during Pregnancy in a Prospective Cohort of Women with Psoriatic Arthritis and Ankylosing Spondylitis.Arthritis Care & Research (2019), doi: 10.1002/acr.23924