SAT0345 PREGNANCY RATES AND OUTCOMES IN EARLY AXIAL SPONDYLOARTHRITIS: ANALYSIS OF THE DESIR COHORT
Authors: Marion Pons, Nathalie Costedoat-Chalumeau, Karine Briot, Philippe Goupille, Christian Roux, Maxime Dougados, Anna Moltó
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Only scarce data is available on regarding pregnancy rates and pregnancy outcomes in early axial Spondyloarthritis (axSpA). Objectives: a) to estimate the probability of achieving a clinical pregnancy over time and its associated factors in early axSpA, b) to estimate the probability of presenting an unfavorable pregnancy outcome over time and its associated factors in this population. <h3>Methods:</h3> Observational prospective French cohort (DESIR) with 6y of follow-up, including 381 of TNFi-naïve women with early axSpA. Study visits were scheduled every 6 months in the first two years of follow up then yearly up to 6 years. Data on pregnancy were collected both retrospectively (before cohort inclusion) and prospectively (since inclusion) up to 6 years of follow up. Baseline characteristics of nulligravidae and uni/multigravidae patients where compared. The probability of achieving at least one pregnancy over time was estimated (Kaplan Meier). Associated factors were estimated by multivariable 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) since associated factors were collected also prospectively. Associated factors to an unfavourable pregnancy outcome were estimated by multivariable Frailty Shared Models and mixted models. <h3>Results:</h3> Of the 381 women included in the analysis, 276 (72.4%) and 105 (27.6%) women were respectively multigravidae and nulligravidae at the end of the 6y follow-up. Multigravidae women were significantly older (37.2±8.0 vs 27.6±7.1, p&lt;0.01), less educated (56.7% vs 71.2% university studies, p=0.01), reported higher fatigue levels (6.3±2.1 vs 5.7±2.4, p=0.02), higher BASDAI (4.9±1.9 vs 4.4±1.9, p=0.03), and higher BASFI (3.6±2.4 vs 2.8±2.2, p=0.003) scores at baseline. The probability to have at least one pregnancy throughout life was 61.8% [55.1-67.5]. The mean age at the first pregnancy was 27.3 years old. One hundred and twenty-four pregnancies occurred during follow-up. The probability to have at least one clinical pregnancy during this period was 28.5% [0.2-0.3]. Lack of TNFi use in the 6 months preceding the pregnancy outcome (HR=2.0 [95%IC 1.1-3.3], p=0.01) and a CRP≥ 6mg/L (HR=1.7[95%IC 1.2-2.5], p= 0.01) were found to be associated with a 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 (15.0%) 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 a voluntary interruption of pregnancy and 6 (7.5%) were pregnancies still ongoing at the end of follow-up. Only NSAID use (HR=2.5[95%IC 1.1-5.0], p=0.02) within 6 months of delivery were associated with an unfavorable outcome. TNFi use during pregnancy (6 patients) was not associated with an unfavorable outcome (HR= 2[95%IC 0.8-5.0], p=0.10). <h3>Conclusion:</h3> More than 70% patients within this early axSpA 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, probably reflecting clinical practice from 10 years ago, when recommendation was to withdraw TNFi before pregnancy. NSAID use within 6 months of delivery was independently associated with an unfavorable pregnancy outcome, while TNFi use was not. <h3>Disclosure of Interests:</h3> Marion Pons: None declared, Nathalie Costedoat-Chalumeau: None declared, Karine Briot Consultant for: Karine Briot has received consultancy honoraria and conference fees from UCB, Amgen, Lilly and MSD, Philippe Goupille Grant/research support from: Financial compensation received from MSD on a pro-rota basis for participation in Scientific Committee meetings and functions for this study, Speakers bureau: Abbvie, Biogaran, BMS, Hospira, Janssen, MSD, Pfizer, Sanofi-Genzyme, UCB, Christian Roux Grant/research support from: Alexion, Amgen, UCB, maxime dougados Grant/research support from: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Anna Moltó: None declared