Background Spondyloarthropathy (SpA) is a chronic inflammatory condition of the spine affecting mainly the male population however the incidence amongst the female population is increasing. The peak incidence of SpA is in the reproductive age group. There has been a lack of focus on pregnancy in SpA as compared to other autoimmune condition such as Lupus and Rheumatoid arthritis, but this is changing. There is a paucity of information (1) on fertility and pregnancy outcomes in this condition compared to other diseases and this may lead to inequality in healthcare delivery.
To review the pregnancy outcomes in women with SpA in our unit
To review ankylosing spondylitis activity during pregnancy
To improve the quality of care in this group of patients by developing local pathways and appropriate MDT involvement
Methods This is a retrospective case review of pregnancies in women with SpA booked at a large tertiary teaching hospital over three years between January 2014 and December 2016. We have an annual delivery rate of 11,000 maternities. The maternity electronic database and clinic diaries were used to identify the cases. A standardised proforma was used to collect and collate the data for demographics, pre pregnancy counselling, disease activity and pregnancy outcome.
Results Six pregnancies were identified in the study period. All patients were under the care of a Rheumatologist. The maternal age range was between 28 and 35 years. The BMI ranged between18 and 37. Ethnicity included 5 caucasian and one Asian woman. Five women had previous pregnancies and one was in her first pregnancy. Two of the multiparous women had previously delivered by caesarean section. Three of the six women suffered from anxiety and/or depression and one had fibromyalgia. Two of the six patients were not on any medication at the start of pregnancy and didn't require any during pregnancy. Four women needed various analgesics and one patient was on sulfasalazine but stopped this at 5 weeks' gestation. NSAIDs was stopped in 3 women after confirmation of pregnancy. One patient who was on Anti TNF therapy discontinued the drug preconception. We observed 50% attended specialist maternal-fetal medicine and anaesthetic services. One patient saw a physiotherapist and accessed hydrotherapy during pregnancy.
Two of six patients delivered preterm (<37 weeks) and 4 delivered at term (>37 weeks). Of the preterm deliveries, 1 went into spontaneous labour not related to disease flare and the other was delivered electively for fetal concerns. All the women delivered by caesarean section. One was planned as an elective caesarean for maternal request due to difficulty abducting legs. All the remaining caesarean deliveries were for obstetric indications not related to SpA.
Conclusions This small observational case series did not highlight any worsening SpA disease activity or poor pregnancy outcome. Further larger studies are required. However a care pathway for managing this group of patients would help to standardise the care during pregnancy. A multidisciplinary approach is essential to optimise the quality of care for these patients.
Pregnancy outcomes in patients with ankylosing spondylitis: a nationwide register study Gustav L Jacobson, Olof Stephansson, Johan Askling and Lennart T H Jacobsson Ann Rheum Dis 2016 75: 1838–1842.
Disclosure of Interest None declared