Background/Purpose:

A significant part of patients with inflammatory arthritis are at their reproductive ages. Anti-tumor necrosis factor-alpha (Anti-TNF) agents are one of the relevant treatment options for inflammatory arthritis which may cause fetal morbidity and mortality. Anti-TNF studies for pregnancy outcomes are mostly related with maternal exposure. In male patients, there are limited studies related to the fetal risks associated with the use of anti-TNF alfa agents before preconception period.

The objective of this study was to assess fetal loss, who used to anti-TNF agents during preconception period in male patients with inflammatory arthritis.

Methods:

A questionnaire was performed to 160 male  patients admitted to our outpatient clinic between July 2015 and July 2016 who use anti-TNF alfa agents. Patients were asked whether their wifeÕs had got pregnant after the start of anti-TNF agents. If their wifeÕs had got pregnant we asked about pregnancy outcomes.

Results:

Totally, 42 (39 AS, 2 RA, 1 PsA) male patientsÕ wife had pregnancy during patients continue to anti-TNF agents. General characteristics of the patients whose wife had got pregnant was shown in the table. The mean age of patients was 36.4 ± 5.2 years. Median disease duration was 10 (IQR=11) years. Thirty-eight (90.5%) patients had live births and all newborns were healthy. The median gestation week was 39 (IQR = 3) weeks. Four (10.5%) births were preterm (ended in <37 gestation week). Mean birth weight of newborns was 3229 gram (gr) (SD = 582). Thirty-one (81.6%) newborn had normal (2500-4000 gr) birth weights. Four had low and 3 had high birth weights.

One pregnancy of a RA patient using etanercept and methotrexate was terminated due to oligohydramnios at 37^th gestation week. The birth weight was 2850 gr and newborn was healthy.

One prenancy of 35-years-old male AS patient using Adalimumab was ended in live birth in normal gestational week and normal birth weight but newborn diagnosed as Angelman Syndrome in the following.

Three (7.9%) out of 38 live births hospitalized in intensive care unit after delivery. The indications of ICU admission were unknown.

On the other hand, 3 (7.1%) pregnancies were ended in spontaneous abortions and ??1 (2.4%) pregnancy were terminated with curettage. No congenital malformations were found in connection to paternal exposure.

Conclusion:

Our study is one of the most extensive studies which provides the male number of patients and the pregnancy outcomes related to men in the literature. Study results suggest that anti-TNF drugs could be safe following paternal exposure.

Table. General characteristics of the patients participating in the study