Pregnancy rates and outcomes in early axial spondyloarthritis: An analysis of the DESIR cohort - 06/03/21
, Maxime Dougados a, b, Nathalie Costedoat-Chalumeau b, c, d, Karine Briot a, b, Philippe Goupille e, f, Christian Roux a, b, Anna Molto a, bBienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | Patients who achieved a clinical pregnancy were more likely to have discontinued their TNFi 6 months prior to the pregnancy outcome and to have an increased CRP at the previous visit, reflecting clinical practice in France before 2010. |
• | 12/80 (15.0%) patients presented an unfavorable pregnancy outcome, and NSAID use within 6 months of outcome was found to be an independent risk factor while TNFi use was not. |
Abstract |
Objectives |
Only scarce data is available regarding pregnancy outcomes in early axSpA, particularly little is known about the impact of disease activity. The objective is to identify (a) the factors associated with the occurrence of a clinical pregnancy during follow-up and (b) the risk factors for an unfavorable pregnancy outcome (e.g. miscarriage, medical termination or pre-term delivery) in an early axSpA population.
Methods |
Observational prospective French cohort (DESIR) with 6 years of follow-up including 381 TNFi-naïve women with early axSpA. Factors associated with a clinical pregnancy occurring over follow-up and risk factors for an unfavorable pregnancy outcome were estimated by multivariable multilevel models (i.e. Frailty Shared Models and Mixed Models).
Results |
During follow-up, 124 pregnancies occurred. Patients who got pregnant during follow-up were more likely to have discontinued their TNFi treatment in the 6 months preceding the pregnancy (HR=2.0 [95% CI 1.1–3.3], P=0.01) and to have an increased CRP at the previous visit (HR=1.7 [95% CI 1.2–2.5], P=0.01). Full-term delivery was by far the most frequent pregnancy outcome (75% of all pregnancies), and only NSAID use in the 6 months prior to the outcome was associated with an unfavorable outcome (OR=2.5 [95% CI 1.1–5.0], P=0.02). No association was found between TNFi use and an unfavorable pregnancy outcome.
Conclusion |
Full-term delivery was the most frequent pregnancy outcome. NSAID use within 6 months of outcome, but not TNFi use, was associated with an unfavorable pregnancy outcome in this early axSpA cohort.
Le texte complet de cet article est disponible en PDF.Keywords : Spondyloarthritis, Pregnancy, Epidemiology
Plan
Vol 88 - N° 2
Article 105075- mars 2021 Retour au numéro
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