Greater Use of Assisted Reproductive Techniques but Comparable Obstetric Morbidity in a Population of Women with Spondyloarthritis: A Matched Comparative Analysis of the GR2 Prospective Cohort and the French National Perinatal Surveys

Sabrina Hamroun¹, Grégoire Martin De Frémont², Nathalie Costedoat-chalumeau³, Marion couderc⁴, René-Marc Flipo⁵, Jérémie Sellam⁶, Christophe Richez⁷, Rakiba Belkhir⁸, Laure Gossec⁹, Hubert Marotte¹⁰, Emmanuelle Dernis¹¹, Aline Frazier¹², Elisabeth Gervais¹³, Cedric Lukas¹⁴, Valerie Devauchelle¹⁵, Alban Deroux¹⁶, Véronique Le Guern¹⁷, Gaëlle Guettrot-Imbert¹⁸, Nathalie Lelong¹⁹, Camille Le Ray¹⁹, Raphaele Seror²⁰ and Anna Molto²¹, and ENP 2021 and GR2 Study Groups, ¹Cochin University Hospital, Paris, Ile-de-France, France, ²Le Kremlin-Bicêtre University Hospital, Le Kremlin-Bicêtre, Guyana, ³University Paris Cité, Paris, France, ⁴CHU de Clermont-Ferrand, Clermont-Ferrand, ⁵CHU Lille, Lille, Nord-Pas-de-Calais, France, ⁶Saint-Antoine Hospital - AP-HP, Paris, Ile-de-France, France, ⁷Pellegrin Hospital, Rheumatology, Referral Center for Rare Systemic Autoimmune and Autoinflammatory Diseases, Bordeaux, France, ⁸Service de Rhumatologie, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France, ⁹Sorbonne Université, Paris, France, ¹⁰Université Jean Monnet, CHU Saint-Etienne, Mines Saint-Etienne, INSERM SAINBIOSE 1059, Saint-Etienne, France, ¹¹CH LE MANS, LE MANS, Pays de la Loire, France, ¹²Lariboisière University Hospital, Paris, France, ¹³University hospital, Poitiers, France, ¹⁴Rheumatology department, CHU Montpellier, Montpellier, France, ¹⁵UBO, Brest, France, ¹⁶Clinique Universitaire de Médecine Interne, Department of Internal Medicine, Grenoble University Hospital, Grenoble, France, ¹⁷APHP, Hôpital Cochin, Paris, ¹⁸Cochin Hospital, Paris, France, ¹⁹University of Paris, INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Paris, France, ²⁰Service de Rhumatologie, Hôpital Bicêtre, AP-HP, le Kremlin Bicetre, Ile-de-France, France, ²¹Groupe Hospitalier Cochin, AP-HP, Paris, France

Meeting: ACR Convergence 2024

Keywords: Cohort Study, pregnancy, spondyloarthritis

Session Information

Date: Saturday, November 16, 2024

Title: Reproductive Issues in Rheumatic Disorders Poster

Session Type: Poster Session A

Session Time: 10:30AM-12:30PM

Background/Purpose: Spondyloarthritis (SpA) regularly affects women of childbearing age¹. A higher obstetric morbidity in women with SpA is suggested in the literature in several countries, but no comparison between SpA patients and women in the general population is available for France. Furthermore, there is very few data on fertility in SpA patients. The aim of the study was to compare use of medically assisted reproduction and adverse fetal, maternal and pregnancy outcomes in women with SpA with matched controls from the French general population.

Methods: We conducted a matched comparative study of SpA patients included in the GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares) national multicentre cohort from 2014 to June 2021 and controls from the French general population included in the French national perinatal surveys (Enquête Nationale Périnatale)². The latter is a national survey carried out for one week every 5 years and recording around 13 000 births. As births before 22 gestational week (GW) and birth weights < 500 grams were excluded from the French national perinatal survey, the same exclusion criteria were applied to women with SpA from the GR2 cohort. Each pregnancy in patients with SpA was matched to 4 pregnancies in controls on age group (≤ 29, 30-34, 35-39, or ≥ 40 years), parity, area of residence, and gemellity. These matching variables were chosen according to their association with adverse pregnancy outcomes (potential confounders). Births in the GR2 cohort between 2015 and 2018 were matched to births in the 2016 survey and those between 2019 and 2021 were matched to births in the 2021 survey. RStudio’s MatchIt package was used to match SpA patients to controls. The frequency of each adverse pregnancy outcome was compared between the two groups using Fisher’s exact test or Chi-2. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated for each variable.

Results: Of the 126 SpA patients included in the GR2 cohort, 116 pregnancies were selected after excluding births before 22 GW and/or birth weight < 500 grams. They were matched with 464 control pregnancies from the French national perinatal survey (224 pregnancies from the 2016 survey and 240 from the 2021 survey). The mean age of SpA patients was 32.0 (+/- 4.1) years and 54.3% were nulliparous. 54.8% of them were treated with biologics during pregnancy. The use of assisted reproductive techniques was higher in women with SpA 12.9% versus 7.1% (OR 1.95 95% CI [1.02-3.76]). However, there was no significant difference between the two populations regarding preterm birth, gestational diabetes, fetal macrosomia, gravidic hypertension, low birth weight, severe postpartum hemorrhage, maternal or fetal transfer to intensive care unit or congenital malformation (Table 1).

Conclusion: Women with SpA in the GR2 cohort required assisted reproductive techniques more frequently than control women from the French general population. However, the obstetrical issues were comparable in this selected population of women who were mostly treated with TNF inhibitors during pregnancy. This study therefore provides useful information for improved management of women of childbearing age with spondyloarthritis.

Table 1. Matched comparative analysis of use of assisted reproductive techniques and adverse fetal, maternal and pregnancy outcomes in SpA patients (GR2 cohort) and control women of the French general population (2016 and 2021 French national perinatal surveys).

Disclosures: S. Hamroun: None; G. Martin De Frémont: None; N. Costedoat-chalumeau: Bristol-Myers Squibb(BMS), 1; M. couderc: None; R. Flipo: AbbVie/Abbott, 2, Bristol-Myers Squibb(BMS), 2, Eli-Lilly, 2, Fresenius kabi, 7, Galapagos, 7, Janssen-Cilag, 2, Lilly, 7, Medac, 7, MSD, 2, Nordic Pharma, 2, Novartis, 2, Pfizer, 2, Roche-Chugaï, 2, Sandoz, 2; J. Sellam: AbbVie/Abbott, 7, Bristol-Myers Squibb(BMS), 7, Fresenus kabi, 7, Galapagos, 7, Grunenthal, 7, MSD, 7, Nordic Pharma, 7, Novartis, 7, Pfizer, 7; C. Richez: None; R. Belkhir: None; L. Gossec: AbbVie, 2, 5, Amgen, 2, Biogen, 5, Bristol-Myers Squibb (BMS), 2, Celltrion, 2, Eli Lilly, 2, 5, Galapagos, 2, Janssen, 2, MSD, 2, Novartis, 2, 5, Pfizer, 2, Sandoz, 2, UCB, 2, 5; H. Marotte: AbbVie/Abbott, 4, 5, 6, Biogen, 5, 6, Bristol-Myers Squibb(BMS), 5, 6, Celltrion Healthcare, 5, 6, Eli Lilly, 5, 6, Fresenius Kabi, 5, 6, Galapagos, 5, 6, Janssen, 5, 6, Merck/MSD, 5, 6, Nordic Pharma, 5, 6, Novartis, 5, 6, Pfizer, 5, 6, Roche, 5, 6, Sanofi, 5, 6; E. Dernis: AbbVie/Abbott, 2, Amgen, 2, Boehringer-Ingelheim, 2, Celgene, 2, Eli Lilly, 2, Galapagos, 2, Gilead, 2, Janssen, 2, Merck/MSD, 2, Nordic Pharma, 2, Novartis, 2, Pfizer, 2, Roche, 2, roche-chugaï, 2, Sandoz, 2, Sanofi, 2, UCB, 2; A. Frazier: None; E. Gervais: None; C. Lukas: None; V. Devauchelle: AbbVie, 2, BMS, 2, 5, Chugai, 5, Galapagos, 2, Janssen, 2, Lilly, 2, 5, Novartis, 2, Pfizer, 2; A. Deroux: None; V. Le Guern: None; G. Guettrot-Imbert: None; N. Lelong: None; C. Le Ray: None; R. Seror: Amgen, 6, Boehringer-Ingelheim, 2, Bristol-Myers Squibb(BMS), 2, GlaxoSmithKlein(GSK), 2, Janssen, 2, Pfizer, 6, Roche, 6; A. Molto: AbbVie, 2, 5, MSD, 2, 5, Pfizer, 2, 5, UCB, 2, 5.

To cite this abstract in AMA style:

Hamroun S, Martin De Frémont G, Costedoat-chalumeau N, couderc M, Flipo R, Sellam J, Richez C, Belkhir R, Gossec L, Marotte H, Dernis E, Frazier A, Gervais E, Lukas C, Devauchelle V, Deroux A, Le Guern V, Guettrot-Imbert G, Lelong N, Le Ray C, Seror R, Molto A. Greater Use of Assisted Reproductive Techniques but Comparable Obstetric Morbidity in a Population of Women with Spondyloarthritis: A Matched Comparative Analysis of the GR2 Prospective Cohort and the French National Perinatal Surveys [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/greater-use-of-assisted-reproductive-techniques-but-comparable-obstetric-morbidity-in-a-population-of-women-with-spondyloarthritis-a-matched-comparative-analysis-of-the-gr2-prospective-cohort-and-the/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/greater-use-of-assisted-reproductive-techniques-but-comparable-obstetric-morbidity-in-a-population-of-women-with-spondyloarthritis-a-matched-comparative-analysis-of-the-gr2-prospective-cohort-and-the/