Background/Purpose: Only scarce data is available on regarding pregnancy rates and pregnancy outcomes in early axial spondyloarthritis (axSpA). The objectives of this study were to estimate the probability of achieving a clinical pregnancy and presenting an unfavorable pregnancy outcome, and determined their associated factors, in this population.

Methods: Observational prospective French cohort (DESIR) with 6y of follow-up, including 381 of TNF-naïve women with early axSpA. Study visits were scheduled every 6 months in the first two years and then yearly up to 6 years. Data on pregnancy were collected retrospectively (before cohort inclusion) and prospectively (since inclusion) up to 6y of follow-up. Baseline characteristics of nulligravidae and uni/multigravidae patients were compared. The probability of achieving at least one pregnancy over time was estimated (Kaplan Meier). Associated factors were estimated by Frailty Shared Models and mixed models taking into account the correlation between several pregnancies from the same women. The probability to present an unfavorable pregnancy outcome over time (i.e a miscarriage or pre-term delivery or an elective termination of pregnancy) was estimated only during the prospective period (Kaplan Meier). Associated factors to an unfavorable pregnancy outcome were estimated by multivariable Frailty shared Models and mixted models.

Results: Of the 381 women included in the analysis, 289 (75.9%) and 92 (24.1%) women were respectively multigravidae and nulligravidae at the end of the 6y follow-up. Multigravidae women were significantly older (36.7±8.2 vs 27.8 ± 7.2, p< 0.01), less educated (56.9% vs 72.5% university studies, p=0.01), and had higher BASDAI (4.9±1.9 vs 4.4±2.0, p=0.04), and higher BASFI (3.5±2.4 vs 2.8±2.2, p=0.008) scores at baseline. The probability to have at least one pregnancy throughout life was 61.8% [55.1-67.5]. The mean age of the first pregnancy was 27.3 years old.  One hundred and twenty-four pregnancies occurred during follow-up. Lack of TNFi use in the 6 months preceding the pregnancy outcome (HR=2.0 [95%CI 1.1-3.3], p=0.01) and a CRP≥ 6mg/L (HR=1.7 [95%CI 1.2-2.5], p=0.01) were found to be associated with pregnancy over follow-up.
Among the 80 pregnancies occurring after inclusion with data available on the outcome, 60 (75%) presented a full-term delivery while 12 (15%) presented an unfavorable pregnancy outcome (6 (7.5%) and 6(7.5%) had a miscarriage or a pre-term delivery, respectively), 2(2.5%) had an elective abortion, and 6(7.5%) were pregnancies still ongoing at the end of follow-up. The probability to present an unfavorable outcome was 16.7% [0.1-0.2]. Only NSAID use (HR=2.5 [95%CI 1.1-5.0], p=0.02) within 6 months of delivery were associated with an unfavorable outcome.

Conclusion: More than 70% patients had at least one pregnancy. A favorable pregnancy outcome (i.e.full-term delivery) was observed in 75% of patients, which is comparable to the general population data. Patients who achieved a pregnancy were more likely to have stopped their TNFi 6 months prior to the pregnancy outcome, and increased their CRP at the previous visit. NSAID use within 6 months of delivery was independently associated with an unfavorable pregnancy outcome.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-rates-and-outcomes-in-early-axial-spondyloarthritis-analysis-of-the-desir-cohort/