Background/Purpose: Women with spondyloarthritis (SpA) are often affected by the disease during their reproductive years¹. However, little is known about the impact of the disease and its treatments on fertility and pregnancy outcomes, as well as the effect of pregnancy itself on disease activity².
The aim of the study was to determine the effects of spondyloarthritis on fertility and pregnancy outcomes in women with SpA.

Methods: We searched Pubmed, Embase, and Web of Science until 1 November 2019, without any language restriction. All studies assessing fertility, pregnancy outcomes and disease activity during pregnancy in women with spondyloarthritis (axial SpA (axSpA) but also peripheral SpA, including psoriatic arthritis (PsA)) were eligible. The heterogeneity between studies was quantified (I²), and multiple meta-regressions were carried out to identify potential sources of heterogeneity. In case I² was < 50%, a random-effects model was used to pool the available data. Prevalence of events was described as percentages. The odds ratio (OR) and corresponding 95% confidence interval (CI) were used to assess the associations between the disease and the pregnancy outcomes.

Results: Within 4397 eligible studies, 21 articles fulfilling the selection criteria were included in the review, assessing overall 3306 patients (2578 with axSpA and 728 with PsA) and 4104 pregnancies compared to 42248 healthy controls (in 11 studies with a control group). Among the included studies, the risk of bias was evaluated as high, moderate and low in respectively 12, 1 and 8 studies.

Regarding pregnancy outcomes, several studies report an increased risk of preterm birth (pooled OR 1,64 [1,15-2,33], I²=24% in axSpA and pooled OR 1,62 [1,23-2,15], I²=0,0% in PsA), small for gestational age (pooled OR 2,05, [1,09-3,89], I²=5,8% in axSpA), preeclampsia (pooled OR 1,59, [1,11-2,27], I²=0% in axSpA) and caesarean section (pooled OR 1,70 [1,44-2,00], I²=19,9% in axSpA and pooled OR 1,71 [1,14-2,55], I²=74,3% in PsA), without any other unfavourable pregnancy outcome (miscarriage, stillbirth or gestational diabetes). Further analysis found a significant higher risk for elective caesarean (pooled OR 2,64, [1,92-3,62], I²=0,0% in axSpA and pooled OR 1,47, [1,15-1,88], I²=0,0% in PsA), without increased risk for emergency caesarean in PsA. There was no substantial heterogeneity in the majority of meta-analyses.

Conclusion: Although based on observational data, this work is to our knowledge, the first systematic review and meta-analysis concerned with this subject. SpA seems to be associated with an increased risk of preterm birth, small for gestational age, preeclampsia and caesarean section. The analysis of the impact of pregnancy on disease activity in this setting is currently ongoing.

Fig. 1 Flow Chart

Fig. 2 Risk of emergency caesarean section in psoriatic arthritis and axial spondyloarthritis patients

Fig. 3 Risk of elective caesarean section in psoriatic arthritis and axial spondyloarthritis patients

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fertility-and-pregnancy-outcomes-in-women-with-spondyloarthritis-a-systematic-review-and-meta-analysis/