Pregnancy Complications More Prevalent in Women With Axial Spondyloarthritis

Pre-eclampsia, low birth weight, preterm births, as well as with other complications, are more common in patients with axial spondyloarthritis (axSpA), according to a study published in Seminars in Arthritis and Rheumatism.¹

“Understanding the impact of axSpA on pregnancy outcomes is a vital component of improving management of women with axSpA at every stage of their lives,” investigators stated. “Improved data collection via national registries have been key to recent advances in the understanding of the impact of rheumatic disease on pregnancy.”

The Ankylosing Spondylitis Registry of Ireland (ASRI) records epidemiological data on axSpA in Ireland. Information obtained from this registry, including demographics, treatment, pregnancy outcomes, fetal outcomes, and breastfeeding, was compared with global reference norms (GRN). Investigators focused on complications, such as miscarriage, pre-eclampsia, gestational diabetes, low birth weight, neonatal intensive care unit (NICU) admission, and pre-term delivery.

Eligible patients were aged 18 years or older, clinically diagnosed with axSpA by a rheumatologist, and met Assessment of Spondyloarthritis International Society (ASAS) classification criteria.

A total of 98 women with axSpA (mean age 43.9 years) were included in the study, with 297 live births (335 pregnancies) recorded. Nearly half of pregnancies (48.5%, n = 162) had at least 1 complication and 13.1% experienced multiple complications.

When compared with GRN, 2 of the most prevalent complications reported in women with axSpA were preterm birth (12.5% vs 5.2%, p<0.01) and pre-eclampsia (6.8% vs 2.8%, p<0.01). Odds ratio calculations indicated that patients with axSpA were 2.48 times more likely to develop pre-eclampsia and 2.52 times more likely to experience preterm birth.

Low birth weight was seen more often in patients with axSpA (8.2% vs 2.9%, p<0.01, respectively). Interestingly, infants who were small for gestational age was less prevalent in the axSpA group when compared with GRN (5.4% vs 11%, p<0.01, respectively).

Miscarriage affected 56 (16.7%) of women with a history of pregnancy and a caesarean section was reported in 13.3% of women.

While most patients (72.4%) had either no change or stable disease prior to pregnancy, 31.6% of women experienced increased disease activity after conception. Remission rates improved in the postpartum period (56.1%).

Limitations of the study included the pregnancy data available in the ARSI, which did not account for maternal age or axSpA treatment during pregnancy. Another limitation was the retrospective, cross-sectional design of the study, which may have led to recall bias.

“These results provide much needed insight into the impact of axSpA in pregnancy and highlight the need for further research to understand the pathogenesis of these complications,” investigators concluded.

Reference:

Sinead Maguire, Fiona Wilson, Phil Gallagher, Muhanad MS Mohamed, Senan Maher, Finbar O'Shea. What to Expect when Women with Axial Spondyloarthritis are Expecting: Prevalence of Complications of Pregnancies in Women with Axial Spondyloarthritis, Seminars in Arthritis and Rheumatism, 2022,151993, ISSN 0049-0172, https://doi.org/10.1016/j.semarthrit.2022.151993.