Impact of Postpartum on Patients with Inflammatory Rheumatic Diseases: The P2Rheum Study

Marie Hornez¹, Anna Molto², Maxime Leroy³, beatrice banneville⁴, Rakiba Belkhir⁵, elodie chauvet⁶, Marion Couderc⁷, Emanuelle Dernis⁸, sandra Desouches⁹, Valerie Devauchelle¹⁰, Aline Frazier-Mironer¹¹, Laure Gossec¹², elisabeth Gervais¹³, Hubert Marotte¹⁴, Christophe Richez¹⁵, Jeremie SELLAM¹⁶, Raphaele Seror¹⁷, Véronique Le Guern¹⁸, Gaelle Guettrot-Imbert¹⁸, Nathalie Costedoat-Chalumeau¹⁹, Rene-Marc Flipo²⁰ and Jean-Guillaume Letarouilly²¹, ¹University of Lille, Lille, France, ²HOPITAL COCHIN AP-HP, Service de Rhumatologie, Paris, France, ³CHU Lille - Department of Biostatistics, Lille, France, ⁴Sorbonne universite and Pitié Salpêtrière Hospital, la Garenne Colombes, France, ⁵Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France, ⁶CH Perpignan, Perpignan, France, ⁷CHU Gabriel Montpied, Clermont Ferrand, France, ⁸CH Le Mans, Le Mans, France, ⁹Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris, Paris, France, ¹⁰UBO, Brest, France, ¹¹APHP Lariboisiere Hospital, Paris, France, ¹²Sorbonne Université and Pitié Salpêtrière Hospital, Paris, France, ¹³CHU Poitiers, Poitiers, France, ¹⁴CHU Saint-Etienne, Saint-Etienne, France, ¹⁵Université de Bordeaux, Bordeaux, France, ¹⁶Sorbonne Université APHP, Paris, France, ¹⁷University Hospital Paris Saclay, Le Kremlin-Bicêtre, France, ¹⁸APHP Hôpital Cochin, Paris, France, ¹⁹Inserm DR Paris 5, Paris, France, ²⁰La Lettre du Rhumatologue, Paris, France, ²¹CHU Lille, Lille, France

Meeting: ACR Convergence 2023

Keywords: pregnancy, rheumatoid arthritis, spondyloarthritis

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: There are limited data on the impact of the postpartum period (PP) on the activity of inflammatory rheumatic disorders (IRD), and the data available on the impact of breastfeeding on the activity of IRD are contradictory. The objectives of this analysis were to describe disease activity and treatments received during the PP period and breastfeeding frequency and its possible impact on IRD activity.

Methods: A descriptive study from a French multicenter prospective observational cohort (GR2) studying pregnant women with IRD i.e. rheumatoid arthritis (RA) and spondylarthritis (SpA) confirmed by a rheumatologist was conducted (NCT 02450396). Data were collected during several regular pre-conception visits, visits during pregnancy and visits around 6- and 12-months PP, from October 2014 to October 2022. Disease activity was assessed with DAS28-CRP for RA and BASDAI and ASDAS for SpA. Flares were defined according to physician judgment. The change in disease activity was investigated by paired Student’s t-tests and Mac-Nemar Chi-2 tests for paired data, as appropriate. Subgroup bivariate comparisons by IRD pathology were performed according to patients’ breastfeeding status at 6-months PP by Kruskal-Wallis tests for continuous variables and Fisher exact tests for categorical variables. There was no imputation of missing data.

Results: Overall, 218 pregnant patients were analyzed: 124 with SpA and 94 with RA. The mean age was 31.8 ± 5.0 and 32.8 ± 5.0 years, respectively for SpA patients and RA patients (Table 1). In SpA patients, there were no significant differences in terms of activity (flares, BASDAI and ASDAS) at 6 months PP compared to during pregnancy. However, CRP level was significantly higher during pregnancy compared to 6 months PP (7 mg/L vs 3.2 mg/L; p = 0.014) (Table 2). RA patients presented significantly more flares in the first 6 months PP compared to pregnancy (62.0% vs 43.5% p = 0.02).Disease activity measures were similar between both SpA and RA patients who still breastfed at six months PP and patients who never breastfed or stopped before 6 months.

After one-year PP, among SpA patients, the number of flares were significantly higher than during pregnancy (40.3% vs 13.4%; p < 0.001). For RA patients, the mean activity and the number of flares were not different during pregnancy and at one year PP. Regarding treatment, about 40% of SpA and RA patients resumed bDMARD during PP, mainly in the first month PP (Table 3). For SpA, all bDMARDs were TNF inhibitors except for one treatment with belimumab (patient with SpA and systemic lupus erythematosus). For RA, among bDMARDs prescribed, 38/45 (84.4%) were TNF inhibitors (tocilizumab, abatacept and JAK inhibitors were the remaining).

Conclusion: RA patients presented significantly more flares in the first 6 months of postpartum compared to pregnancy while SpA patients remained stable. Yet, in both diseases, only about 40% of the patients resumed bDMARD during post-partum period. Breastfeeding was not associated with an increase or decrease in disease activity in SpA and RA patients.

Legends: Data are expressed in mean and standard deviation (sd) or number and percentages. SpA: spondyloarthritis; RF: rheumatoid factor; ACPA: Anti-citrullinated protein antibody)

Legends: Data are expressed in median and interquartile or number and percentages. Disease activity was defined for SpA according to BASDAI or ASDAS-CRP: BASDAI < 2 for remission and BASDAI ≥ 4 for high activity; ASDAS-CRP <1.3 for remission, ASDAS-CRP> 1.3 and <2.1 for low activity, ASDAS-CRP> 2.1 for moderate to high activity; DAS28-CRP<2.6, for low activity, DAS28-CRP >2.6 and <3.2, and DAS28-CRP>3.2 for medium to high activity. BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; ASDAS: Ankylosing Spondylitis Disease Activity Score; DAS28-CRP: Disease Activity Score based on 28 tender and swollen joints and C reactive protein.

Legends: Date are expressed in number and percentages. SpA : Spondylarthritis; RA : rheumatoid arthritis; PP : post-partum; bDMARDs : biological Disease-Modifying AntiRheumatic Drugs ; MTX : Methotrexate.

Disclosures: M. Hornez: None; A. Molto: None; M. Leroy: None; b. banneville: None; R. Belkhir: None; e. chauvet: None; M. Couderc: None; E. Dernis: AbbVie/Abbott, 2, Amgen, 2, Bristol-Myers Squibb(BMS), 2, Celgene, 2, Eli Lilly, 2, Galapagos, 2, Gilead, 2, Janssen, 2, MSD, 2, Nordic Pharma, 2, Novartis, 2, Pfizer, 2, Roche, 2, Roche-Chugai, 2, Sandoz, 2, Sanofi, 2, UCB Pharma, 2; s. Desouches: None; V. Devauchelle: None; A. Frazier-Mironer: None; L. Gossec: AbbVie, 2, 12, Personal fees, Amgen, 2, Biogen, 5, BMS, 12, Personal fees, Celltrion, 12, Personal fees, Eli Lilly, 5, 12, Personal fees, Galapagos, 12, Personal fees, Janssen, 12, Personal fees, MSD, 12, Personal fees, Novartis, 5, 12, Personal fees, Pfizer, 12, Personal fees, Sandoz, 5, 12, Personal fees, UCB Pharma, 5, 12, Personal fees; e. Gervais: None; H. Marotte: None; C. Richez: AbbVie/Abbott, 2, 6, Amgen, 6, AstraZeneca, 2, 6, Bristol-Myers Squibb(BMS), 6, Eli Lilly, 6, 12, receipt of drugs, GlaxoSmithKlein(GSK), 2, 6, Novartis, 2, 6, Pfizer, 2, 6; J. SELLAM: None; R. Seror: None; V. Le Guern: None; G. Guettrot-Imbert: None; N. Costedoat-Chalumeau: None; R. Flipo: AbbVie, 2, Bristol-Myers Squibb(BMS), 2, Eli Lilly, 2, Janssen, 2, Medac, 2, MSD, 2, Nordic Pharma, 2, Novartis, 2, Pfizer, 2, Roche-Chugaï, 2, Sandoz, 2, Sanofi, 2; J. Letarouilly: None.

To cite this abstract in AMA style:

Hornez M, Molto A, Leroy M, banneville b, Belkhir R, chauvet e, Couderc M, Dernis E, Desouches s, Devauchelle V, Frazier-Mironer A, Gossec L, Gervais e, Marotte H, Richez C, SELLAM J, Seror R, Le Guern V, Guettrot-Imbert G, Costedoat-Chalumeau N, Flipo R, Letarouilly J. Impact of Postpartum on Patients with Inflammatory Rheumatic Diseases: The P2Rheum Study [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/impact-of-postpartum-on-patients-with-inflammatory-rheumatic-diseases-the-p2rheum-study/. Accessed .

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