Pregnancy in patients affected by axial-spondyloarthritis: a narrative review of disease activity and obstetric outcomes.

IF 1.2 Q4 RHEUMATOLOGY
M Filippini, G Fontana, P Bizioli, F Crisafulli, R Orabona, S Zatti, F Franceschini, A Tincani
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Abstract

Objective: This review aims to summarize the most recent and updated data on pregnancy in patients with axial spondyloarthritis (axSpA), focusing on the recurrence of pregnancy-related complications, the disease activity throughout gestation and the postpartum, and the latest indications for the treatments of future mothers.

Methods: We have conducted a narrative review with an online literature search on Medline and PubMed. We selected only studies written in English published until January 2024, including observational and retrospective studies, meta-analyses, and systematic reviews.

Results: Proper preconception counseling and maternal-fetal monitoring are necessary to ensure the best outcome for both the mother and her baby. Despite the limited and conflicting evidence about the prevalence of adverse pregnancy outcomes in women with axSpA compared to healthy controls, primary findings demonstrate an increased risk of preterm delivery (PTD), low birth weight (LBW), and elective cesarean section (CS). Concerning disease activity, data suggests that 25-80% of women with ankylosing spondylitis experience disease flares during pregnancy, particularly around 20 weeks of gestation. On the contrary, the data on the postpartum disease flare are heterogeneous. The use of biological drugs in pregnancy is safe and effective in controlling disease activity.

Conclusions: Data on pregnancy outcomes in patients with axSpA are scarce and discordant. Probably the difference in maternal disease classification, the evolution of treatment indications, and the differences emerging from study designs can account for these discrepancies. The main evidence shows an increased risk of PTD, LBW, and elective CS (although the latter may reflect cultural influences rather than medical needs due to axSpA itself). The majority of drugs used to treat axSpA, including TNFi, are safe in pregnancy without harming mothers or fetuses. Further data is needed to clarify many controversial aspects in this area.

轴性脊柱关节炎患者的妊娠:疾病活动和产科结果的叙述性回顾。
目的:本综述旨在总结有关轴性脊柱关节炎(axSpA)患者妊娠的最新数据,重点关注妊娠相关并发症的复发、整个妊娠期和产后的疾病活动以及未来母亲治疗的最新适应症:我们在 Medline 和 PubMed 上进行了在线文献检索,并进行了叙述性综述。我们只选择了 2024 年 1 月之前发表的英文研究,包括观察性和回顾性研究、荟萃分析和系统综述:适当的孕前咨询和母胎监测对确保母婴获得最佳结果非常必要。尽管与健康对照组相比,有关 axSpA 妇女不良妊娠结局发生率的证据有限且相互矛盾,但主要研究结果表明,早产(PTD)、低出生体重(LBW)和选择性剖宫产(CS)的风险增加。关于疾病活动性,有数据表明,25%-80%的强直性脊柱炎妇女在妊娠期间,尤其是在妊娠 20 周左右会出现疾病复发。相反,有关产后疾病复发的数据却不尽相同。在妊娠期使用生物制剂可安全有效地控制疾病活动:结论:有关轴性SpA患者妊娠结局的数据很少,而且不一致。母体疾病分类的差异、治疗适应症的演变以及研究设计的不同可能是造成这些差异的原因。主要证据显示,PTD、低体重儿和选择性剖宫产的风险增加(尽管后者可能反映了文化的影响,而非 axSpA 本身的医疗需求)。用于治疗 axSpA 的大多数药物(包括 TNFi)在妊娠期都是安全的,不会对母亲或胎儿造成伤害。要澄清这一领域的许多争议性问题,还需要更多的数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Reumatismo
Reumatismo RHEUMATOLOGY-
CiteScore
2.10
自引率
7.10%
发文量
20
审稿时长
10 weeks
期刊介绍: Reumatismo is the official Journal of the Italian Society of Rheumatology (SIR). It publishes Abstracts and Proceedings of Italian Congresses and original papers concerning rheumatology. Reumatismo is published quarterly and is sent free of charge to the Members of the SIR who regularly pay the annual fee. Those who are not Members of the SIR as well as Corporations and Institutions may also subscribe to the Journal.
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