Background/Purpose: Current recommendations advocate maintaining pregnancy-compatible bDMARDs during pregnancy (mainly TNF inhibitors) and monitoring disease activity before conception to improve disease and pregnancy outcomes. Recently, the Spanish BIOBADASER¹ registry showed low use of bDMARDs during pregnancy, but data from patients followed in dedicated pregnancy clinics is lacking. Our objective was to describe the current use of bDMARDs in a specialized pregnancy clinic and the impact of preconception counseling (PC) on disease activity and pregnancy outcomes.

1. Membrive-Jiménez C, Sánchez-Piedra C, Martínez-González O, et al. Safety and effectiveness of bDMARDs during pregnancy in patients with rheumatic diseases: Real-world data from the BIOBADASER registry. Reumatol Clin (Engl Ed). 2023;19(9):500-506.

Methods: Our objective was to describe the current use of bDMARDs in a specialized pregnancy clinic and the impact of preconception counseling (PC) on disease activity and pregnancy outcomes.

Results: 41 pregnancies in 30 patients were included. Five (12.2%) pregnancies ended with miscarriage and 1 (2.4%) with voluntary pregnancy interruption. The remaining 35 pregnancies in 28 patients were analyzed. Main characteristics are reported in table 1.  71.4% of patients continued bDMARDs during pregnancy, 9 (36%) had started a bDMARD after PC. There were no differences regarding age at conception, disease diagnosis and duration, comorbidities and obstetric history.  8 (22,9%) patients became pregnant after assisted reproductive therapies, all in the bDMARDs group.  PC was most frequent among bDMARDs group (88%), since 60% of the group that dropped out were pregnant on the first visit. Treatment before and during pregnancy is reported in table 2. After treatment adjustments, 76% of the bDMARD group were considered suitable for pregnancy compared to 10% of the discontinuation group ( p=0.001).Treatment before and during pregnancy is reported in Table 2. There were 17 flares (37.8%), 13 (76.5%) were articular flares, 2 (11.8%) vasculitis flare, 1 (5.9%) uveitis and 1 (5.9%) worsening of thrombocytopenia. 90% (9/10) of discontinuation group flared during pregnancy compared to 32% (8/25) in bDMARDs group (p=0.003), with a mean of 17.4 (8.1) GW, requiring restart of bDMARDs in 2 (11.8) pregnancies and increased dose of glucocorticoids in 88.2%. Two ( 2/35; 5.7%) patients are currently pregnant. Data about the 33 pregnancies ended with live-birth are reported in table 3. Discontinuation group had non-statistical significant shorter pregnancies, a higher proportion of preterm deliveries and smaller babies. Overall, they had more complications during pregnancy, 88,9% compared to 16.7%, mainly gestational diabetes (37.5%) and preterm delivery (37.5%). There was one case of preeclampsia and one case of intrauterine growth restriction, both in the discontinuation group.

Conclusion: Up to 71.4% maintained bDMARDs during pregnancy, mainly TNF-i. Maintenance of DMARDs was more frequently after PC in a specialized pregnancy clinic, improving disease control and pregnancy outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-bdmards-during-pregnancy-after-preconceptional-counseling-in-spanish-patients-with-rheumatic-diseases/