P256 Complications in Pregnancy are Common in Women with Axial Spondyloarthropathy: Data from the Ankylosing Spondylitis Registry of Ireland
Authors: Maguire Sinead , Wilson Fiona , Gallagher Phil , O'Shea Finbar 
Published: April 2022

Abstract

Background/Aims
National registries are excellent data sources to allow analysis of inflammatory arthritis such as axial spondyloarthropathy (axSpA). Our understanding of axSpA has evolved rapidly over time resulting in improved recognition of the disease. Unfortunately for women with axSpA, there are limited data on pregnancy outcomes in this population. To address this issue, data were collected on pregnancy within the Ankylosing Spondylitis Registry of Ireland (ASRI), which is a source of epidemiological data on axSpA in Ireland. The aim of this study was to examine the prevalence of pregnancy and fetal complications in women with axSpA.

Methods
The ASRI records information on baseline demographics, imaging, medications, patient outcomes and comorbidities. For enrolment, all patients must have been diagnosed with axSpA by a rheumatologist and meet the ASAS criteria. Informed consent was obtained from all patients, with ethical approval obtained from local hospital ethics committees. A dedicated section collects data on pregnancy, fertility and breastfeeding. ASRI outcomes data for women with axSpA were recorded retrospectively.

Results
At the time of analysis, 220 women were enrolled in the ASRI, representing 24.3% of the total population of the registry. Mean age of women was 43.9 years, with a mean disease duration of 18 years and mean delay to diagnosis of 7.86 years. 68.6% (151) had radiographic sacroiliitis, while 49.5% (109) had sacroiliitis on MRI. Mean scores for women in the ASRI were: BASDAI 4.6, BASFI 3.82, BASMI, HAQ 0.6, and ASQoL 7.65. Data on pregnancy were available in 76 women, with 61 women reporting a total of 210 pregnancies resulting in 166 live births. Of these pregnancies, 58.1% (122) were uncomplicated and 41.9% (88) were complicated, with 11.4% (24) of pregnancies encountering multiple complications. The frequency of miscarriage was high, affecting 20.5% (43) of pregnancies overall in 37.7% (23) of women with a history of pregnancy. Of the pregnancies resulting in live births, the most common pregnancy complication was caesarean section in 10.8% (18) followed by preterm delivery in 11.4% (15), while the most common fetal complication was NICU admission in 11.4% (19). Only four women (5.3%) reported difficulty conceiving and the need for fertility specialist referral, but none underwent assisted reproductive therapy. Prevalence of breastfeeding was low, reported in only 33.7% (56) of live births.

Conclusion
Data from the ASRI indicates a high frequency of pregnancy and fetal complications in women with axSpA. These results represent a preliminary analysis of pregnancy outcomes in axSpA pregnancies collected via a large national registry. Ongoing data collection will allow comparison to national averages. This provides much needed insight into the impact of axSpA on pregnancy, which can be used to improve monitoring and management of women with axSpA during their pregnancies.

Disclosure
S. Maguire: Grants/research support; Recipient of the Gilead Inflammation Fellowship. F. Wilson: None. P. Gallagher: None. F. O'Shea: None.