EULAR Report: Cesarean Deliveries Higher in Spondyloarthritis

Spondyloarthritis is associated with an increased risk of preterm births, small gestational age infants and elective cesarean section deliveries, according to study data presented on June 4 at the European Congress of Rheumatology (EULAR) annual meeting.

Spondyloarthritis often affects women in child-bearing age. The disease has a major impact on quality of life and family planning for these patients. However, little is known about the impact of  spondyloarthritis and its treatments on fertility and pregnancy outcomes.

Sabrina Hamroun, of the Cochin Hospital in Paris, France, presented the data from what she referred to as the first systematic review and meta-analysis to summarize if fertility or pregnancy outcomes are altered in spondyloarthritis, and whether pregnancy affects disease activity.

“Our results highlight the need for a multidisciplinary approach, including obstetricians, rheumatologists and anesthesiologists,” Dr. Hamroun said.

A total of 21 studies were included in the review. All studies assessed fertility, pregnancy outcomes and disease activity during pregnancy in women with axial and peripheral spondyloarthritis, including psoriatic arthritis. Overall, 3,306 patients were included, with 4,104 pregnancies, and compared with 42,248 healthy controls. There was a lack of data on fertility in women with spondyloarthritis.

“Regarding pregnancy outcomes, we found a 60 percent increase in the risk of pre-term birth and caesarean section in both axial spondyloarthritis and psoriatic arthritis, as well as an almost twice higher risk of small gestational age and preeclampsia, mainly in axial forms of spondyloarthritis,” Hamroun said.

For caesarean section delivery, the increased risk was driven by elective procedures rather than emergency ones. Hamroun noted that previous studies have found several risk factors for caesarean section deliveries in women with spondylarthritis, including maternal age, long-duration and extensive treatment of the disease, and preeclampsia.

Different outcome definitions, study designs, and timing of assessment made it difficult summarize data on disease activity. However, Hamroun said that disease activity seemed to stay relatively stable during pregnancy, with a potential small increase during the second trimester for axial spondyloarthritis. For the post-partum period, disease activity worsened in both axial spondyloarthritis and psoriatic arthritis. Hamroun suggested that this may be related to the disease activity at conception.

There was a lack of data on fertility in women with spondyloarthritis. Hamroun recommended that further evidence is needed, especially on fertility,  in women with spondylarthritis.

A separate study presented on June 4 at the EULAR annual meeting by Imke Redeker, of the German Rheumatism Research Centre in Berlin, also found that women with axial spondylarthritis had a higher risk of caesarean section deliveries. Redeker and colleagues used claims data from 611 singleton births among 535 women with axial spondylarthritis and found that the women also had a tendency for preterm births an small gestational age infants.

REFERENCE

FRI 305 Fertility and pregnancy outcomes in women with spondyloarthritis: a systematic review and meta-analysis. Sabrina Hamroun. 11:50 a.m., Friday, June 5. 2020 EULAR E-Congress

FRI306 Women with axial spondyloarthritis have comparable rates of complications in pregnancy to women in the general population but more caesarean deliveries: results from nationwide claims data. Imke Redeker. 11:50 a.m., Friday, June 5. 2020 EULAR E-Congress