Pregnancy Outcomes in Patients with Ankylosing Spondylitis: A Nationwide Population Study

Yao-Fan Fang, Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Taoyuan, Taiwan

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Ankylosing spondylitis (AS), epidemiologic methods and pregnancy

Session Information

Date: Tuesday, November 7, 2017

Session Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment III

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Pregnancy outcomes in patients with ankylosing spondylitis: a nationwide population study.

Background/Purpose: Autoimmune inflammatory diseases influence on pregnancy outcomes. But rare studies have focus on the ankylosing spondylitis (AS) and pregnancy outcomes.

Methods: The primary data source was the National Health Insurance database and national birth registry of Taiwan. We obtained records of all pregnancies in Taiwan between 2001 and 2012 from a national insurance database. Maternal and fetal outcomes were obtained from national birth registry.

Results: We analyzed data from 2,350,339 women between 2001 and 2012 categorized into 2 groups. Subjects in the reference group (2,347,847 women) had no AS diagnosis, and those in the AS group (2,492 women) had diagnosed with AS before pregnancy. Maternal outcomes in patients with AS revealed a higher adjusted odds ratio for Puerperal cerebrovascular disorders (OR 4.05 95% CI 2.02 to 8.12), Preterm labor (OR 1.18 95% CI 1.00 to 1.38), cesarean delivery (OR 1.08 95% CI 1.01 to 1.15), pulmonary edema (OR 4.99 95% CI 1.24 to 20.10) and gestational diabetes (OR 1.16 95% CI 1.02 to 1.34). The neonatal outcomes in AS group showed a higher adjusted OR for poorer 1 minute Apgar score (<7) (OR 1.38 95% CI 1.10 to 1.75), poorer 5 minute Apgar score (<7) (OR 1.60 95% CI 1.02 to 2.52), fetal abnormalities (OR 1.20 95% CI 1.03 to 1.39), chromosomal abnormalities (OR 1.72 95% CI 1.15 to 2.59) and unspecific abnormalities (OR 1.28 95% CI 1.01 to 1.62).

Conclusion: Patients with AS were associated with higher prevalence of adverse birth outcomes.

Table 1. Comparison of maternal outcomes between pregnancies associated with maternal AS or not.

Pregnancies N (%)

Crude Odds ratio

(95% CI)

Adjusted Odds ratio_

(95%CI)

Without AS

(n= 2,347,847)

With AS

(n=2,492)

Overall outcomes

Death _30 days post-partum

314

(0.01)

(0.00)

N/A

Death _1 year post-partum

793

(0.03)

(0.00)

N/A

Cardiovascular

Acute myocardial

111

(0.00)

N/A

Aneurysm

(0.00)

N/A

Cardiac arrest/ ventricular fibrillation

116

(0.00)

N/A

Heart failure

144

(0.01)

(0.00)

N/A

Shock

1,191

(0.05)

(0.08)

1.58

(0.40-6.28)

1.28

(0.32-5.14)

Conversion of cardiac rhythm

555

(0.02)

(0.00)

N/A

Pregnancy-related hypertension

53,984

(2.30)

(2.61)

1.14

(0.89-1.48)

0.91

(0.72-1.16)

Gestational hypertension

23,028

(0.98)

(1.00)

1.03

(0.69-1.54)

0.78

(0.52-1.15)

Puerperal cerebrovascular disorders

1,705

(0.07)

(0.32)

4.33

(2.12-8.85)*

4.05

(2.02-8.12)*

Thrombotic embolism

214

(0.01)

(0.08)

4.59

(0.65-32.3)

3.8

(0.53-27.1)

Complication during delivery

Amniotic fluid embolism

232

(0.01)

(0.00)

N/A

Antepartum hemorrhage

209,662

(8.93)

257

(10.31)

1.18

(1.03-1.34)*

1.10

(0.97-1.24)

Postpartum hemorrhage due to atony

12,621

(0.54)

(0.76)

1.43

(0.91-2.24)

1.17

(0.75-1.84)

Postpartum hemorrhage not due to atony

3,501

(0.15)

(0.16)

1.08

(0.41-2.88)

0.89

(0.33-2.37)

Severe postpartum hemorrhage

63,287

(2.70)

(3.33)

1.24

(0.99-1.56)

1.23

(0.99-1.53)

Preterm labor

106,014

(4.52)

148

(5.94)

1.34

(1.13-1.59)*

1.18

(1.00-1.38)*

Premature rupture of membranes

(0.00)

N/A

Chorioamnionitis

8,057

(0.34)

(0.28)

0.80

(0.38-1.67)

0.75

(0.36-1.57)

Cesarean delivery

781,237

(33.27)

992

(39.81)

1.33

(1.23-1.44)*

1.08

(1.01-1.15)*

Induction of labor

117

(0.00)

N/A

Surgical complications

Severe anesthesis complications

302

(0.01)

(0.00)

N/A

Thorax, abdomen, and pelvis injuries

968

(0.04)

(0.00)

N/A

Intracranial injuries

5,585

(0.24)

(0.16)

0.65

(0.24-1.80)

0.79

(0.30-2.10)

Blood transfusion

13,296

(0.57)

(0.60)

1.09

(0.66-1.80)

0.91

(0.55-1.52)

Hysterectomy

1,859

(0.08)

(0.12)

1.51

(0.49-4.66)

1.26

(0.41-3.91)

Operations on heart and pericardium

1,605

(0.07)

(0.08)

1.22

(0.31-4.82)

0.88

(0.22-3.51)

Other

Adult respiratory distress syndrome

1,011

(0.04)

(0.08)

1.80

(0.45-7.16)

1.46

(0.36-5.84)

Sepsis

5,867

(0.25)

(0.32)

1.29

(0.65-2.58)

1.06

(0.53-2.12)

Disseminated intravascular coagulation

1,541

(0.07)

(0.08)

1.22

(0.31-4.82)

0.94

(0.24-3.77)

Preeclampsia

37,046

(1.58)

(1.97)

1.25

(0.93-1.68)

1.03

(0.78-1.36)

pulmonary edema

330

(0.01)

(0.08)

5.86

(1.47-23.4)*

4.99

(1.24-20.10)*

Temporary tracheostomy

103

(0.00)

N/A

Ventilation

19,810

(0.84)

(1.24)

1.50

(1.06-2.14)*

1.04

(0.73-1.49)

Seizures among preeclamptic patients

1,690

(0.07)

(0.00)

N/A

Gestational diabetes

126,485

(5.39)

204

(8.19)

1.58

(1.36-1.83)*

1.16

(1.02-1.34)*

_Adjusted for age, infant sex, Charlson comorbidity index, urbanization, income, occupation, birth year, maternal nationality

*p<0.05

Table 2. Comparison of neonatal outcomes between pregnancies associated with maternal AS or not.

Pregnancies N (%)

Without AS

(n= 2,347,847)

With AS

(n=2,492)

Crude Odds ratio

(95% CI)

Adjusted Odds ratio

(95% CI)_

Stillbirth

17,346

(0.74)

(0.68)

0.93

(0.57-1.49)

0.81

(0.50-1.30)

explained stillbirth

1,766

(0.08)

(0.12)

1.60

(0.52-4.97)

1.38

(0.44-4.28)

unexplained stillbirth

15,580

(0.66)

(0.56)

0.85

(0.50-1.44)

0.75

(0.44-1.26)

Low birth weight (<2500 g)

151,048

(6.43)

173

(6.94)

1.19

(1.03-1.38)*

1.06

(0.91-1.22)

Prematurity (<37 week)

178,059

(7.58)

219

(8.79)

1.10

(0.94-1.30)

1.10

(0.96-1.26)

Small for gestational age

227,984

(9.71)

221

(8.87)

0.91

(0.78-1.05)

0.97

(0.85-1.11)

Large for gestational age

231,066

(9.84)

227

(9.11)

0.91

(0.79-1.05)

0.85

(0.74-0.97)

APGAR SCORE 1 min (<7)

46,844

(2.00)

(2.85)

1.45

(1.14-1.83)*

1.38

(1.10-1.75)*

APGAR SCORE 5 min (<7)

12,194

(0.52)

(0.76)

1.48

(0.94-2.32)

1.60

(1.02-2.52)*

Fetal distress

116,442

(4.96)

125

(5.02)

1.00

(0.83-1.20)

1.00

(0.84-1.19)

Fetal abnormalities, any

105,705

(4.50)

165

(6.62)

1.52

(1.29-1.79)*

1.20

(1.03-1.39)*

Central nervous system malformations

10,085

(0.43)

(0.32)

0.73

(0.36-1.48)

0.67

(0.33-1.34)

Chromosomal abnormalities

10,207

(0.43)

(0.92)

2.15

(1.40-3.30)*

1.72

(1.15-2.59)*

Hereditary disease in family possible affecting fetus

1,863

(0.08)

(0.16)

1.95

(0.66-5.71)

1.55

(0.58-4.12)

Suspected damage due to viral or other disease in the mother

3,122

(0.13)

(0.28)

2.26

(1.09-4.69)*

1.62

(0.77-3.40)

Suspected damage due to drugs or radiation

923

(0.04)

(0.00)

N/A

decreased fetal movements

33,970

(1.45)

(2.37)

1.66

(1.28-2.17)*

1.17

(0.91-1.51)

Other/unspecified abnormalities

42,411

(1.81)

(2.77)

1.59

(1.24-2.04)*

1.28

(1.01-1.62)*

_Adjusted for age, infant sex, Charlson comorbidity index, urbanization, income, occupation, birth year, maternal nationality

*p<0.05

Disclosure: Y. F. Fang, None;

To cite this abstract in AMA style:

Fang YF. Pregnancy Outcomes in Patients with Ankylosing Spondylitis: A Nationwide Population Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/pregnancy-outcomes-in-patients-with-ankylosing-spondylitis-a-nationwide-population-study/. Accessed December 10, 2018.

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