Background Planning a pregnancy in rheumatoid arthritis (RA) meets several issues, mostly concerning potential drug toxicity and disease flares.
Objectives The purpose of this study is to evaluate pregnancy planning, RA activity during pregnancy and postpartum, pregnancy and fetal outcomes in a Romanian cohort of female patients diagnosed with RA.
Methods We designed an observational ambispective study which included 36 RA Caucasian females with obstetric history after the onset of RA (14 - prospective, 22 - retrospective). The cases were obtained from several Clinics of Rheumatology from Romania.
Results The mean age at inclusion is 39.88 years, age at RA diagnosis 24.97 years and mean age at conception 31.03 years.
We recorded a total number of 65 pregnancies: 29 deliveries at term, 3 premature births, 12 elective abortions, 20 spontaneous abortions (attributed to trombophilia, methotrexate [MTX], Leflunomide and Toxoplasmosis gondii) and 1 ongoing.
24/36 (66.6%) had only one pregnancy after the onset of RA and 7/36 (19.4%) were multipares before the diagnosis. 47.6% had at least one unplanned pregnancy, while being on treatment with DMARDs.
Concerning the exposure to synthetical DMARDs during the pregnacy:
5 patients received Leflunomide and 2 received MTX during the first trimester, the pregnancy outcomes being: 2 spontaneous abortion, 2 elective abortions, 2 normal birth, 1- premature twin pregnancy.
In case of biologic DMARDs: 2 were exposed to Etanercept until weeks 2 and 3 (normal birth), and 1 to Infliximab – week 4 (elective abortion). In patients receiving Rituximab the washout period varied from 4 weeks in 2 pregnancies (1- spontaneous abortion and 1 normal birth) to 48 weeks (2 normal births and 1 premature).
We registred 3 patients on biological therapy, which stopped the treatment with 2 years before the planned preganncy (Etanercept), respectivelly 6 months (Etanercept and Adalimumab)
66.6 of our patients were in Remission or Low Disease Activity (DAS28CRP) at preconception.
Maintaing or improvement of the disease activity during the pregnancy were the principal trend in our population, excepting 2 situations.
The average pregnancy length was 35.2 weeks, with 3 preterm deliveries and the mean birthweight was 2624 grams. No fetal abnormality was identified
Five patients never had a new flare postpartum, while in the others the mean time to flare postpartum was 9 weeks
Conclusions Patients with RA can have successful pregnancies. The pregnancy is planned in about half of cases. Pregnancy decreases disease activity, but many deliveries are followed by RA flares. No fetal abnormalities were diagnosed.
Pregnancy in autoimmune rheumatic diseases: The importance of counselling for old and new challengesL.Andreoli, C Bazzani M.Tarabo-relli, R. Reggia, A. Lojacono, A. Brucato, P.L Meroni, A. Tincani, Autoimmunity Reviews 10 (2010) 51–54
Disclosure of Interest None declared