Spondyloarthritis in the peripartum period: a systematic review of current knowledge and clinical implications.

Abstract

Background: Spondyloarthritis (SpA) commonly affects women of reproductive age, yet evidence on fertility, pregnancy outcomes and postpartum disease activity remains fragmented. The growing recognition of non-radiographic axial SpA (axSpA) and the wider use of biologics have increased the need for reproductive-health data in this population.

Objectives: To systematically review the evidence on fertility, pregnancy course, therapeutic management, obstetric and neonatal outcomes and postpartum disease activity in women with SpA.

Design: Systematic literature review.

Methods: We performed a systematic search of PubMed/MEDLINE using predefined MeSH-based equations addressing fertility, pregnancy and the postpartum period in SpA. English and French studies were included without date restriction. Data extraction followed a PICO/PECO framework and findings were synthesized thematically according to PRISMA guidance.

Results: Of 337 publications identified, 167 met the inclusion criteria. Evidence indicates a modest reduction in ovarian reserve and longer time-to-pregnancy in some women with SpA, partly influenced by non-steroidal anti-inflammatory drugs (NSAIDs) exposure. Disease activity during pregnancy is generally stable in PsA but more variable in axSpA; flares occur in up to 40% of pregnancies, especially after biologic discontinuation. Overall pregnancy outcomes are favourable, though risks of preterm birth, caesarean delivery and small-for-gestational-age infants are modestly increased. Biologic therapies, especially tumour necrosis factor inhibitors, appear safe and contribute to disease control. Postpartum flares are common, particularly in axSpA, and breastfeeding is generally compatible with most treatments.

Conclusion: When disease activity is well controlled and treatment is optimized, reproductive outcomes in women with SpA are largely favourable. Avoiding unnecessary NSAID exposure, maintaining appropriate biologic therapy when indicated and close peripartum monitoring are key to improving outcomes. High-quality prospective studies remain needed to refine clinical guidance.