Birth Outcomes and Disease Activity during Pregnancy in a Prospective Cohort of Women with Psoriatic Arthritis and Ankylosing Spondylitis

Chelsey J F Smith¹, Arthur Kavanaugh² and Christina D Chambers³, ¹Rheumatology, University of California San Diego, La Jolla, CA, ²University of California, San Diego, School of Medicine, La Jolla, CA, ³University of California San Diego Department of Pediatrics, La Jolla, CA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Ankylosing spondylitis (AS), Disease Activity, pregnancy and psoriatic arthritis

Session Information

Date: Tuesday, October 23, 2018

Title: Reproductive Issues in Rheumatic Disorders Poster

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: The goal of this prospective cohort study is to add to the limited data on birth outcomes in psoriatic arthritis (PsA) and ankylosing spondylitis (AS) and to describe patterns of disease activity during pregnancy in these diseases.

Methods: Women enrolled as part of the Organization of Teratology Information Specialists (OTIS) Autoimmune Disease in Pregnancy Project before 20 weeksÕ gestation from 2004-2018. Delivery of at least one live-born infant was eligibility criteria for analysis. Data on pregnancy events, medications, disease activity, and outcomes were obtained by maternal report and validated by medical records. Disease activity was calculated by the Health Assessment Questionnaire (HAQ) or Routine Assessment of Patient Index Data 3 (RAPID3). Poisson regression with robust standard errors was used to estimate risk ratios (RR), multivariable adjusted risk ratios (aRR) and their 95% Confidence Intervals (CI).

Results: In this large prospective cohort analysis, PsA was associated with an increased risk for moderate preterm delivery (aRR 1.81, 95% CI 1.01-3.26), preterm labor (aRR 2.05, 95% CI 1.21-3.48), oligohydramnios (aRR 3.79, 95% CI 1.34-10.74), and caesarian section (aRR 1.63, 95% CI 1.26-2.12), versus healthier comparison women. The AS group had an increased risk for very preterm delivery (aRR 10.19, 95% CI 2.09-49.78), very low birth weight (aRR 11.02, 95% CI 2.24-54.12), and infant hospitalization in NICU (aRR 1.67, 95% CI 1.05-2.67). Disease activity over the course of pregnancy was either stable (by HAQ) or improved (by RAPID3) in PsA, whereas in AS it slightly worsened with both measures, although changes were small in both disease groups (see Figure 1).

Conclusion: Pregnant women with PsA and AS are at increased risk for some adverse pregnancy outcomes. Disease activity is relatively stable over pregnancy, with slight improvement in PsA and slight worsening in AS, although varying by measure of disease activity used. Further analyses would be useful to tease out the role of disease activity and medications on these outcomes.

Disclosure: C. J. F. Smith, None; A. Kavanaugh, None; C. D. Chambers, AAAAI, 2,Hoffman La Roche, 2,Genzyme Sanofi-Aventis), 2,UCB Pharma Inc., 2,Janssen, 2,Pfizer, 2,Celgene Corporation, 2,Takeda, 2,GlaxoSmithKline, 2,Sanofi, 2,Amgen Inc., 2,Sanofi-Aventis, 2,Birth Defects Research, 9.

To cite this abstract in AMA style:

Smith CJF, Kavanaugh A, Chambers CD. Birth Outcomes and Disease Activity during Pregnancy in a Prospective Cohort of Women with Psoriatic Arthritis and Ankylosing Spondylitis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/birth-outcomes-and-disease-activity-during-pregnancy-in-a-prospective-cohort-of-women-with-psoriatic-arthritis-and-ankylosing-spondylitis/. Accessed .

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