THU0389 A SYSTEMATIC REVIEW OF PREGNANCY OUTCOME IN ANKYLOSING SPONDYLITIS
Authors: Gangarathna Krishna, Anuradha Shajpal, Pip Divall, Manjiri Khare, Arumugam Moorthy
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Ankylosing spondylitis (AS) is a chronic, systemic inflammatory arthritis predominantly affecting spine and sacroiliac joints. AS affects young individuals in their third and fourth decades of life. Pregnancy poses challenges in AS patients. Unlike other chronic autoimmune diseases, not much is known regarding pregnancy outcome in AS and a systematic review would help treating clinicians and health professionals. <h3>Objectives:</h3> Our main objective was to evaluate the pregnancy outcomes in ankylosing spondylitis. We reviewed the management and care related to preconception counselling, antenatal,intrapartum and postpartum period,particularly disease activity,medications and birth outcomes. <h3>Methods:</h3> A systematic search of PUBMED and EMBASE was performed. Relevant peer reviewed papers were identified using inclusion criteria which included articles on pregnancy outcomes in AS patients above 16 years. We included only English articles covering systematic reviews, randomized control trials, case reports, observational studies published in medical literature between 1970 and March 2017.We excluded papers discussing general management of AS and articles on other autoimmune diseases and pregnancy. Each author screened the title and abstracts individually based on our criteria. A standardized data collection form was used for assessment of study quality and evidence synthesis. Systematic review was registered in PROSPERO and we followed the PRISMA flow chart. <h3>Results:</h3> Our search yielded 544 papers. After initial screening of the titles and abstracts 443 papers were identified of which 42 potentially relevant papers were selected for full text review. 18 papers were finally included. Our initial results are based on individual papers. Zhou et al studied 12 AS patients retrospectively with no adverse outcomes, all had term pregnancies with 5 normal vaginal delivery, 7 caesarean,delivery was based on obstetric reasons. Nai Lee Lui et al observed a reduction in pain in the first trimester, first month postpartum with increase in the second and third trimester and in up to 6 months postpartum. Monika Ostensen et al observed unaltered or aggravated disease symptoms during pregnancy in 80%. Delivery was mainly uncomplicated and was normal in most cases. A postpartum flare during the first 3 months occurred in 90% of AS pregnancies. Hakan Timur et al did not notice any adverse pregnancy outcomes. Worsening of symptoms was seen in 60-90%of patients up to 6 months after delivery. Jakobsson et al noticed women with AS had a higher prevalence for several adverse birth outcomes with an influence by both disease severity and comorbidities. Case reports highlighted anaesthetic difficulties during delivery. There was paucity of articles studying the treatment aspects and complications only in pregnant AS patients. <h3>Conclusion:</h3> To the best of our knowledge, this systematic review is the first one reviewing the outcome of pregnancy in ankylosing spondylitis. As the studies were heterogeneous, the pregnancy outcome was not consistent. There is paucity of data about pregnancy management for women with AS and further research is needed in this area to guide evidence based management of these pregnancies. <h3>Reference:</h3> [1] Management of pregnancy with ankylosing spondylitis: Zhou, Qian, et al. :Chinese medical sciences journal = Chung-kuo i hsueh k'o hsueh tsa chih; Mar 2012; vol. 27 (no. 1); p. 46-49.The effect of pregnancy on ankylosing spondylitis, psoriatic arthritis, and juvenile rheumatoid arthritis: Ostensen, M: American journal of reproductive immunology (New York, N.Y. : 1989); 1992; vol. 28 (no. 3-4); p. 235-237. Pregnancy outcomes in patients with ankylosing spondylitis: a nationwide register study:Jakobsson, Gustav L, et al: Annals of the rheumatic diseases; Oct 2016; vol. 75 (no. 10); p. 1838-1842. Effect of pregnancy on ankylosing spondylitis: a case-control study: Lui, Nai Lee, et al. : The Journal of rheumatology; Nov 2011; vol. 38 (no. 11); p. 2442-2444 <h3>Disclosure of Interests:</h3> Gangarathna Krishna: None declared, Anuradha Shajpal: None declared, Pip Divall: None declared, Manjiri Khare Speakers bureau: Falk forum speaker honorarium in November 2014, Arumugam Moorthy Speakers bureau: Speaker fee from Abbvie, Novartis.