Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
JIA often continues into adult life and affects about 1 in 1,000 people of childbearing age. Little is known about the impact of JIA and its treatment with non-biologic (nb) and biologic (b) disease modifying antirheumatic drugs on pregnancy and its outcome. We therefore investigated pregnancy outcomes in females with JIA exposed to DMARDs.
Methods
Patients with a pregnancy history, who were enrolled in the JIA biologic registers BiKeR and JuMBO, were interviewed regarding pregnancy complications and outcomes. Prospectively collected patient-reported data on disease activity and functional status, and physician-reported data on treatment and pregnancy-related adverse events were also considered in the analyses.
Results
Out of 875 JIA patients followed into adulthood, 91 pregnancies were reported in 70 patients (58 females patients, 12 partners of male patients). Until June 2014, reports on pregnancies were evaluable for 50 females with 60 pregnancies. The majority had polyarticular JIA (72%), another 16% enthesitis-related arthritis. The median age at conception was 20.9 years (ys, range 13.8-29.0), the median disease duration 11.6 ys (range 3.3-26.1).
All patients were ever treated with bDMARDs (94%) and/or nbDMARDs (100%), 48% were exposed at conception (10 to bDMARDs only, 10 to b and nbDMARDs, 4 to nbDMARDs only). In the group of DMARD exposed (n=25 pregnancies) and unexposed patients (n=35 pregnancies), pregnancy outcomes were as follows: 13 (52%) and 26 (74%) live births, 0 and 1 stillbirth, 1 and 0 extrauterine gravidity, 3 and 3 spontaneous abortions, 8 and 5 elective pregnancy terminations, respectively. DMARDs were discontinued in the exposed patients 4.9 weeks (median, range 2.7-22.3) after conception.
Of 39 pregnancies with live births, complications were reported in two-thirds of the cases, with similar frequency in exposed and unexposed patients. Most frequently reported complications were hyperemesis gravidarum, pregnancy diabetes, urinary obstruction, preterm contractions and hemorrhages (n=5 each). Almost half of the patients (48%) were delivered by Cesarean section. There were 3 pre-term deliveries and 3 small for gestational age neonates. The median birth weight was 3,110 grams (range: 1,080-4,150) after a median gestational age of 39.0 weeks (range: 30-42). No birth defects were reported. Two neonates required intensive neonatal care.
During pregnancy, disease activity of JIA remained stable or even improved in two-thirds of patients. Within the first 6 months after delivery, about half of women experienced a disease flare. Patients on DMARDs within the 3 months before conception had more often a disease flare than those not being exposed.
Conclusion
Exposure to DMARDs did not seem to increase the risk of adverse pregnancy outcomes, however, that needs to be confirmed in larger patient cohorts. Data suggest that severely affected JIA patients are at risk of pregnancy morbidity and instrumental delivery.
Disclosure:
K. Stüdemann,
None;
M. Niewerth,
None;
J. Klotsche,
None;
A. Zink,
None;
G. Horneff,
AbbVie, Pfizer, and Roche ,
2,
AbbVie, Novartis, Pfizer, and Roche,
8;
K. Minden,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancies-in-females-with-juvenile-idiopathic-arthritis-jia-who-were-exposed-to-biologics-andor-methotrexate-results-from-a-biologic-register/