POS0514 PRECONCEPTIONAL AND GESTATIONAL MANAGEMENT IN INFLAMMATORY SPONDYLOARTHROPATHIES AND PSORIATIC ARTHRITIS. OUTCOME FROM 10 YEARS OF PREGNANCY CARE CLINIC
Authors: F. Rengifo García, A. García Fernández, R. Senosiain Echarte, Á. Navidad Miguel, M. Á. González-Gay, J. A. Martinez Lopez
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> preconceptional assessment in a specialised pregnancy clinic can improve pregnancy outcomes and rheumatic disease control. <h3>Objectives:</h3> our aim was to describe the disease course and pregnancy outcomes of patients with inflammatory spondyloarthropathy (SpA) and psoriatic arthritis (PsA). <h3>Methods:</h3> observational, descriptive and retrospective study of patients undergoing prospective monitoring at a specialised Rheumatology pregnancy clinic in Madrid. Patients with SpA and PsA, who attended the clinic between December 2012 to December 2022, were included. Each episode of pregnancy counselling was considered as a case. Categorical variables were described as proportions and/or percentages, continuous variables as mean and standard deviation, and data comparison was performed using the chi2 test. <h3>Results:</h3> 59 cases were included, with 42 (71,2%) patients diagnosed with SpA and 17 (28,8%) with PsA. The mean age at the first visit (FV) was 34,8 (3,8) years, with 23 (39%) pregnant patients. Pregnant patients at FV had lower gestational risk, and only 2 were on biologic treatment (BT), after preconceptional counselling in a previous pregnancy. Out of the 36 (61%) non - pregnant patients, preconception counselling was provided, 17 (47,2%) were fit to conception, and therapeutic adjustments needed in 19 (52,8%). Teratogenic drugs were discontinued in 6 (10,2%) patients (one after positive pregnancy test), and in 5 (13,9%) patients BT was started. The pregnancy rate was 78%, with a mean age of 35 (3,8) years. There were 7 (15,2%) pregnancies after assisted reproductive therapies, one voluntary pregnancy interruption due to fetal malformation (1,7%), and 2 (4,4%) ongoing pregnancies. During pregnancy, there were 12 (28,9%) flares at an average of 19,4 (4,4%) gestational weeks (GW), including 11 (91,7%) joint flares and 1 (8,3%) uveitis. 7 (58,3%) were treated with glucocorticoids, and in 1 (8,3%) case, the preconceptionally stopped BT was restarted. Flares during pregnancy were associated with active disease at conception [active disease at conception 6/8 (75%), patients in remission 6/37 (16,2%), p = 0,002]. Of the 43 full - term pregnancies, 26 (60,5%) were vaginal deliveries and 9 (20,9%) were caesarean section, at a mean of 39 (1,5) GW. There were 2 (4,4%) preterm deliveries and 4 (9,1%) low birth weight neonates, one of them from a twin pregnancy. Low birth weight was more frequent in pregnant women with flares [pregnant women with flares 3/9 (33,3%), pregnant women without flares 1/29 (3,4%), p = 0,011]. There were 9 postpartum - related flares after a mean of 2,4 (1,5) months. Gestational risk stratification was not associated with adverse pregnancy outcomes. <h3>Conclusion:</h3> pregnancy rate was 78%, with 36 (61%) patients undergoing preconceptional assessment. There was a low rate of preterm birth and low birth weight. Disease activity both before conception and during pregnancy was associated with poorer outcomes. Therefore, the importance of pregnancy planning in a specialised clinic, conceiving during disease remission with compatible treatment, and close monitoring after gestational risk stratification. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>