AB0151 FOLLOW-UP IN A MULTIDISCIPLINARY UNIT IMPROVES PREGNANCY OUTCOME IN INFLAMMATORY ARTHROPATIES ON BIOLOGICAL THERAPY
Authors: O. Ibarguengoitia, I. Calvo, D. Montero, L. Vega, C. García, O. Fernandez, I. Torre, A. R. Inchaurbe, C. E. Perez, J. M. Blanco, E. Cuende, E. Galindez, I. Gorostiza, J. Oraa, M. L. García Vivar, M. E. Ruiz
Journal: Annals of the Rheumatic Diseases (2021)

Background: Women with inflammatory arthropaties have fertility problems and complications during pregnancy and frequently biological therapy (BT) is required for the disease control. Objectives: To evaluate pregnancy in women with inflammatory arthropaties in a multidisciplinary unit composed of Rheumatologists and Obstetricians: describe disease evolution, complications and treatment used (including BT). Methods: Retrospective and descriptive study of the evolution of pregnancy in patients with inflammatory diseases (Rheumatoid Arthritis (RA), Spondyloarthritis (SpA) and Juvenile Idiopathic Arthritis (JIA)) and follow-up in a multidisciplinary unit for more than 15 years (until December 2020). Demographics, maternal disease, time until conception, previous abortions and presence of antibodies were collected. In addition, during follow-up, treatment, abortions, Caesarean sections (C-section), preterm births, disease activity and maternal/fetal complications were collected. Results: We registered 41 pregnancies (32 women): 20 RA (62.5%), 9 SpA (28.1%) and 3 JIA (9.4%). Maternal average age at diagnosis was 27.1±6.6 years and average age at childbirth/abortion was 34.9±5.1 years. It took an average time of 9.6±8.5 months to conceive. 9.8% received fertility treatment with in vitro fertilization techniques. AntiRo antibodies were registered in 7.3% of patients and 34.1% had at least 1 antiphospholipid antibody. At the time of gestational desire/gestation 17 women (12 RA, 4 SpA, 2 JIA) were receiving BT: 7 certolizumab (CZP), 7 adalimumab (ADA), 3 etanercept (ETN). 1 patient was being treated with baricitinib. Due to pregnancy, ADA was changed to CZP in 3 women and BT was stopped in 6 cases (3 ETN, 2 ADA, 1 CZP) as well as baricitinib. In 2 cases, ADA was stopped at week 17 of pregnancy (medical indication). Pregnancy was completed with BT (CZP) in 9 cases. 9 abortions were registered prior to follow-up in the unit (0.28 abortions/mother) and 3 during follow-up (0.09 abortions/mother): 2 of them in women with CZP. C-section was performed in 26.8% of cases. Preterm birth (&lt;37 weeks) happened in 9.7% (n: 4) of the pregnancies: 1 case in a woman with CZP. A total of 17 different fetal/maternal complications were registered during follow-up: 6 in the BT group (35.3%) compared to 11 (64.7%) in the group without BT, being Intrauterine Growth Restriction (IUGR) more frequent among women with BT. Infections were not more common in patients with BT. Complications are listed in Table 1. Table 1. COMPLICATIONS WITH BT (n, %) n: 11 WITHOUT BT (n, %) n: 30 IUGR 3 (27.3%) 1 (3.3%) LOW BIRTH WEIGHT 2 (18.2%) 2 (6.6%) INFECTION 1 (9.1%) 4 (13.3%) CHOLESTASIS 0 (0%) 2 (6.6%) PREECLAMPSIA 0 (0%) 1 (3.3%) DIABETES MELLITUS 0 (0%) 1 (3.3%) HIGH BLOOD PRESSURE 0 (0%) 0 (0%) NEPHROPATY 0 (0%) 0 (0%) NEONATAL LUPUS 0 (0%) 0 (0%) HEART BLOCK (0%) 0 (0%) MALFORMATION 0 (0%) 0 (0%) HELLP SYNDROME 0/0%) 0 (0%) TOTAL 6 (54.6%) 11 (36.4%) Regarding concomitant treatment, low dose prednisone was used in 48.8% of pregnancies, hydroxychloroquine in 51.2%, sulfasalazine in 9.8% and acetylsalicylic acid in 51.2%. We didn´t find differences in the use of these treatments between the two groups. Median DAS28 among RA patients and available data was under 2.6 throughout pregnancy as well as previously and posteriorly. No differences in median DAS28 were found between women with BT and without BT. SpA patients had BASDAI lower than 4 in both groups during pregnancy and previously. Conclusion: In our series, as described in the literature, women with inflammatory arthropaties are older and are more likely to have preterm births compared to general population. Fewer abortions were registered during follow-up in the multidisciplinary unit. Appropriate disease control was maintained during pregnancy, also previously and afterwards. We registered more IUGR and low birth weight among women with BT but given the low number of patients with BT no statistically significant conclusions about complications can be drawn. Therefore, more studies among pregnant women with BT are necessary. Disclosure of Interests: None declared