Background Biologic drugs are effective therapeutic option in patients with juvenile idiopathic arthritis (JIA). However, data regarding their safety during pregnancy and breastfeeding in adult JIA women are rare.
Objectives The purpose of this report is to summarize the pregnancy outcomes in adult female patients with JIA treated with anti-TNF and other biologic agents.
Methods Pregnant patients were prospectively followed since 2003. Length of pregnancy, complications, preterm delivery, birth defects and disease exacerbations after delivery were entered into the database. Patients were treated with biologics in recommended doses for rheumatoid arthritis. Data on disease activity, safety and doses of used medication were extracted from the Czech national registry of patients treated with biologics (ATTRA).
Results Eighteen live births in a total of 19 pregnancies were noted in adult JIA patients. They were diagnosed with RF positive polyarthritis (7), RF negative polyarthritis (7), extended oligoarthritis (4) and psoriatic arthritis (1). The age of mothers at the onset of pregnancy was 25.5 (range 20 -40) years. Seven patients discontinued biologicals shortly before the pregnancy was confirmed. In 12 cases patients were exposed to biological drugs after conception; infliximab in 4 cases, etanercept in 4, adalimumab in 3 and abatacept in 1. Biologic drugs were administered for 6-8 weeks during pregnancy. One patient flared after discontinuation of etanercept and was returned on the drug at week 26 because of severe JIA relapse and the drug was administered until the delivery. Two pregnancies were not planned and both patients were exposed to methotrexate in the first 6 weeks.
One patient treated with infliximab had spontaneous abortion at week 7. Repeated pregnancy in this patient with the exposure to infliximab for 4 weeks was successful. All the other pregnancies were uneventful with just one case of hypertension. The pregnancy was terminated by Caesarean section in three cases (hypertension, limited hip movement and foetus defective position). There was no preterm delivery.
No birth defects were reported. Birth weight was between 2920- 4000 grams.
Conclusions Our data from 19 pregnancies suggest that the use of biologics in the early phases of gravidity in JIA patients is safe and does not affect the pregnancy duration nor the delivery or lead to any birth defects.
Acknowledgements Supported by the project (Ministry of Health, Czech Republic) for conceptual development of research organization 00023728 (Institute of Rheumatology)
Disclosure of Interest None declared