Session Information
Date: Sunday, November 12, 2023
Title: (0460–0479) Reproductive Issues in Rheumatic Disorders Poster I
Session Type: Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Many women with chronic rheumatic inflammatory diseases (CRID) stop tumor necrosis factor inhibitors (TNFi) treatment once pregnancy is confirmed to avoid potential adverse fetal events but taking the risk of inflammatory flare.
The aim of the study was to compare in real life settings the pregnancy outcomes of two treatment strategies among women with CRID: to continue TNFi vs. stop TNFi upon pregnancy diagnosis.
Methods: the French nationwide health insurance database (Système National des Données de Santé) was used to emulate a target trial in adult women, with CRID (i.e., rheumatoid arthritis, psoriatic arthritis or spondyloarthritis), having started a singleton pregnancy between 2008 and 2017, and and being treated with TNFi upon pregnancy diagnosis. We compared the frequency of unfavorable pregnancy outcomes (malformations, obstetrical complications, and infections) between the treatment strategies at pregnancy diagnosis, using inverse probability weighted marginal models.
Results: A total of 2082 singleton pregnancies of CRID women (579 RA and 1503 SpA) exposed to TNFi 6 weeks after last menstrual period were identified; among them, in 1497 (72%) TNFi was discontinued.
Mean (SD) age of women at the start of pregnancy was 31 (5) years and mean (SD) disease duration was 4 (5) years. Continuation of TNFi was not associated with increased frequencies of unfavorable obstetrical nor infant outcomes, and interestingly, the proportion of maternal severe infections (i.e., requiring hospitalization) was significantly lower in the ‘continue’ group (1(0.2%) vs. 19 (1.3%), with an adjusted risk ratio = 0.2 [0.1 – 0.6]).
|
Outcomes |
TNFi continue (n = 584)$ |
TNFi stop (n=1497)$ |
Relative Risk (Continue vs. Stop) 95% CI |
|
|
Obstetrical |
Live births |
505 ( 86.6%) |
1327 ( 88.6%) |
0.9 [0.9 – 1.0] |
|
Spontaneous abortion (GA < 22 WG or birth weight < 500g) |
11 ( 1.9%) |
50 ( 3.3%) |
0.6 [0.3 – 1.2] |
|
|
Intrauterine fetal death (GA >=22 WG or birth weight >=500g) |
6 ( 1.1%) |
8 ( 0.5%) |
2.0 [0.8- 5.3] |
|
|
Medical termination of pregnancy |
4 ( 0.6%) |
15 ( 1.0%) |
0.6 [0.2 – 2.4] |
|
|
Preterm birth (GA between 22 and 37 among live birth) |
37 ( 6.4%) |
108 ( 7.2%) |
0.9 [0.6 – 1.3] |
|
|
Small for GA ( < 10th percentile) |
52 ( 8.9%) |
139 ( 9.3%) |
0.9 [0.7 – 1.4] |
|
|
Cesarean delivery |
115 ( 19.8%) |
337 ( 22.5%) |
0.9 [0.7- 1.1] |
|
|
Eclampsia/Pre-eclampsia |
6 ( 1.0%) |
21 ( 1.4%) |
0.7 [0.3 – 1.6] |
|
|
Extra-uterine pregnancy |
0 ( 0.0%) |
5 ( 0.3%) |
– |
|
|
Maternal |
Hospital admission for infection (during pregnancy and 6 weeks post-delivery ) |
1 ( 0.2%) |
19 ( 1.3%) |
0.2 [0.1 – 0.6] |
|
Gestational diabetes |
59 ( 10.2%) |
155 ( 10.3%) |
0.9 [0.7 – 1.4] |
|
|
Infants |
Major congenital malformation |
12/486 (2.5%) |
37/1293 ( 2.9%) |
0.9 [0.4 – 1.7] |
|
Severe infection (requiring hospitalization) during the first year of life |
51/486 ( 10.6%) |
119/1293 ( 9.2%) |
1.2 [0.8 – 1.7] |
|
|
NCIU admission for more than 48h in infants born after 37 WG |
6/486 ( 1.3%) |
24/1293 ( 1.9%) |
0.7 [0.3 – 1.9] |
$: Weighted pseudopopulation; Abbreviations: GA = gestational age; WG = weeks of gestation
Conclusion: In pregnant women with CRID treated with TNFi until pregnancy diagnosis, unfavorable obstetrical outcomes were not different to those observed when TNFi were maintained, and maternal severe infections were less frequent, when compared with a strategy of stopping TNFi.
To cite this abstract in AMA style:
Molto A, ajrouche a, Tran D, Costedoat-Chalumeau N, Elefant E, Tsatsaris V, Fresson J, Bader-Meunier B, Fautrel B, Tubach F. Continuing TNFi After Pregnancy Diagnosis in Women with Chronic Rheumatic Inflammatory Diseases Is Not Associated with Worse Obstetrical or Infant Outcomes and Seems to Reduce Risk of Maternal Severe Infection: The Results of the Emulated Target Trial BioGRIC [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/continuing-tnfi-after-pregnancy-diagnosis-in-women-with-chronic-rheumatic-inflammatory-diseases-is-not-associated-with-worse-obstetrical-or-infant-outcomes-and-seems-to-reduce-risk-of-maternal-severe/. Accessed .« Back to ACR Convergence 2023
ACR Meeting Abstracts - https://acrabstracts.org/abstract/continuing-tnfi-after-pregnancy-diagnosis-in-women-with-chronic-rheumatic-inflammatory-diseases-is-not-associated-with-worse-obstetrical-or-infant-outcomes-and-seems-to-reduce-risk-of-maternal-severe/