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 This is an observational, ambispective study, including 58 RA Caucasian females with obstetric history after the onset of RA (20 females - prospective, 38 - retrospective). The cases were obtained from several Clinics of Rheumatology from Romania

Results The mean age at inclusion was 37.1 years, age at RA diagnosis 3.9 years and mean age at conception 32.2 years. We recorded a total number of 96 pregnancies: 48 deliveries at term, 4 premature births, 15 elective abortions, 24 spontaneous abortions, and 5 ongoing. 34/96 (35.4%) had at least one unplanned pregnancy, while being on treatment.

Concerning the exposure to synthetic DMARDs during the pregnancy: 6 patients received Leflunomide and 4 received Methotrexate during the first trimester, the pregnancy outcomes being: 3 spontaneous and 3 elective abortions, 3 normal birth (1- Cholestiramine wash-out), 1 premature twin pregnancy.

Regarding biologic DMARDs: 5 were exposed to Etanercept - 3 less than 3 weeks, (2 normal births and one elective abortion- due to Methotrexate use), 2 treated in second trimester: 1 only in the 15th and 16th weeks due to relapse - normal birth, and the other one until week 20, pregnancy still ongoing.

One patient was treated with Certolizumab until week 12, the pregnancy is ongoing, and one with Adalimumab until week 4, the fetus had intrauterine growth restriction, premature birth.

6 patients treated with Rituximab were included, last infusions were: 4 weeks before conception (1- spontaneous abortion and 1 normal birth), 48 weeks (2 normal births and 1 premature), and one at 4 weeks after conception - normal birth.

In 4 cases the patients stopped the biological DMARD before conception: Etanercept 6 months and 2 years, Adalimu-mab,6 months with normal outcome, and for Tocilizumab 9 months (growth restriction)

81.25% of our patients were in Remission or Low Disease Activity (by DAS28CRP) at conception and generally this status was maintained, excepting several situations.

The average pregnancy length was 36.36 weeks and the mean birthweight was 2878.90 grams.2 growth restriction was identified and several atopic dermatitis, no teratogenic effect.

13 patients never had a new flare postpartum and in the others the mean time of postpartum flare was 12.1 weeks

Conclusions Patients with RA can have successful pregnancies. More than 60% of pregnancies have been planned. Pregnancy decreases disease activity, but many deliveries are followed by RA flares. No fetal abnormalities were diagnosed.

References

1. Østensen M, et all. State of the art: Reproduction and pregnancy in rheumatic diseases: Autoimmun Rev. 2015 May;14(5):376–86. doi: 10.1016/j.autrev.2014.12.011. Epub 2014 Dec 30.

References

Disclosure of Interest None declared