FRI0070 PREGNANCY AND OFFSPRING OUTCOME IN RA FEMALE PATIENTS- A BOW BETWEEN CENTURIES
Authors: M. Micu, A. Micu
Journal: Annals of the Rheumatic Diseases (2020)

Background: Clinical and preclinical rheumatoid arthritis (RA) may negatively impact several pregnancy and offspring outcome parameters [1,2]. Objectives: Assessing pregnancy and offspring outcome in RA patients and controls. Methods: RA pregnant patients (G1) were prospectively recruited. Demographic data, disease activity scores, immunology and obstetric/offspring outcome parameters were recorded. The same parameters were retrospectively collected (interview) in RA patients who delivered children before RA onset (G2) and in healthy subjects (C). Ethical committee approval for the study was obtained and all participants signed informed consents. Results: Table 1 presents demographic and disease related data. Table 2 shows the outcome parameters in the 3 groups. G1 delivered babies between the years 2008-2019. CsDMARDs were stopped by the majority of patients in the 1 st trimester of pregnancy; 2 patients continued low dose corticosteroids throughout pregnancy (Fig 1). G2 and C delivered the babies between the years 1963 and 2000. Table 1. Parameter G1 G2 C Subjects^ 22 27 36 Disease duration (y±SD) 5.92±6.14 - - Disease activity* T1-R/LDA/HDA^ 9/15/5 - - T2- R/LDA/HDA^ 15/6/8 T3- R/LDA/HDA^ 18/6/5 RF + (%) 86.36 92.59 - ACPA + (%) 36.36 62.96 - Contraception^ 0 3 5 Fertility treatment^ 1 1 1 ^- number, y- years, SD- standard deviation, R-remission, LDA-low disease activity, HDA-high disease activity, * DAS 28 3 variables, T-trimester Table 1. Parameter G 1 G 2 C p G1 vs G2 p G1 vs C p G2 vs C Pregnancies ^ ¶ 29 70 88 &lt;0.0001 &lt;0.05 &lt;0.05 Children/mother^ 1.31 2.59 2.14 - - - Age at conception y ¶ m;IQR (min-max) 34;6 (28 -44) 23;4.5 (17-38) 23;6.5 (16- 39) &lt;0.0001 &lt;0.0001 &lt;0.05 TTP &gt;12 months (%) £ 37.93 48.57 30.68 &lt;0.0001 &lt;0.05 &gt;0.05 Births ^ ¶ 28 53 67 &lt;0.0001 &lt;0.0001 &gt;0.05 Spontaneous abortions^ £ 10 14 22 &lt;0.0001 &lt;0.0001 &gt;0.05 Stillbirths^ 0 1 0 - - - ‘C ‘section delivery £ (%) 21.42 1.85 1.51 &lt;0.0001 &lt;0.0001 &gt;0.05 Premature delivery £ (%) 7.14 5.66 3.07 &gt;0.05 &gt;0.05 &gt;0.05 Eclampsia (%) 3.57 0 0 - - - Birth weight g (mean ± SD) ¶ 2950±461 3250±652 3500±463 &lt;0.05 &lt;0.0001 &lt;0.05 Birth weight &lt; 2500g (%) 7.14 13.33 1.49 - - - Malformations^ 0 0 1 - - - Transfer to NICU^ 0 1 1 - - - Other child pathologies^ 2 (autism) 0 0 - - - ^- number, y- years, g-gram, NICU- newborn intensive care unit, ¶ Mann Whitney U test, £ Fisher’s exact test, m-median Fig 1: Overall, RA pregnant patients were older at conception, had a lower number of pregnancies/deliveries and a higher rate of spontaneous abortions and ‘C’ sections compared to G2 and C. Time to pregnancy (TTP) was increased in G1 when compared to G2 and C. Both G1 and G2 newborns were smaller for their gestational age versus C, the majority of them still being in the normal range. All these aforementioned parameters showed statistical significance. Number of premature deliveries and pregnancy/offspring pathology events showed a low frequency and no difference was identified between groups when comparing them. Conclusion: Current pregnancy management guidelines implementations in RA assure a good pregnancy course in patients that have achieved remission and LDA status. RA patients show lower fertility and more miscarriages in comparison to both preclinical RA and general population. Newborns from RA mothers are healthy and show a normal gestational age/weight at delivery, yet smaller family sizes were observed. Preclinical RA does not influence fertility, pregnancy outcome and family size. Newborns belonging to G1 and G2 are smaller in comparison to general population but true hypotrophy is a rare event. References: [1]Rom AL, Wu CS, Olsen J, et al. Fetal growth and preterm birth in children exposed to maternal or paternal rheumatoid arthritis: a nationwide cohort study. Arthrtis Rheum 2014; 66(12):3265-73. [2]de Man YA, Hazes JM, van der Heide H, Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum 2009;60:3196-206. Disclosure of Interests: None declared