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Pregnancy and neonatal outcomes in women with axial spondyloarthritis: pooled data analysis from the European Network of Pregnancy Registries in Rheumatology (EuNeP)
  1. Yvette Meissner1,
  2. Anja Strangfeld1,2,
  3. Anna Molto3,4,
  4. Frauke Forger5,
  5. Marianne Wallenius6,7,
  6. Nathalie Costedoat-Chalumeau8,9,
  7. Hilde Bjørngaard7,
  8. Marion Couderc10,11,
  9. René-Marc Flipo12,
  10. Gaëlle Guettrot-Imbert8,
  11. Isabell Haase13,
  12. Bente Jakobsen7,
  13. Hege Suorza Svean Koksvik7,
  14. Christophe Richez14,15,
  15. Jérémie Sellam16,17,
  16. Anja Weiß1,
  17. Astrid Zbinden5,
  18. Rebecca Fischer-Betz18
  19. EuNeP collaborator group
    1. 1 Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
    2. 2 Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
    3. 3 Rheumatology Department, Hospital Cochin, Paris, France
    4. 4 Clinical Epidemiology and Biostatistics, Université de Paris, INSERM U1153, Paris, France
    5. 5 Department of Rheumatology and Immunology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
    6. 6 Institute of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
    7. 7 Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
    8. 8 Internal Medicine Department, Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, Paris, France
    9. 9 CRESS, INSERM, INRA, Université de Paris, Paris, France
    10. 10 Rheumatology Department, University Hospital Centre Clermont-Ferrand, Clermont-Ferrand, France
    11. 11 Inserm/ Imost UMR1240, Clermont Auvergne University, Clermont-Ferrand, France
    12. 12 Service de Rhumatologie, CHU Roger Salengro, Université de Lille, Lille, France
    13. 13 Policlinic for Rheumatology and Hiller Research Institute, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
    14. 14 Service de Rhumatologie, Referral Center for Rare Autoimmune and Systemic Diseases RESO, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
    15. 15 UMR CNRS 5164, Université de Bordeaux Collège Sciences de la Santé, Bordeaux, France
    16. 16 INSERM UMRS_938, Sorbonne Universite, Paris, France
    17. 17 Department of Rheumatology, Hospital Saint-Antoine, Paris, France
    18. 18 Department for Rheumatology and Hiller Research Institute, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
    1. Correspondence to Dr Yvette Meissner, Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Berlin, Germany; y.meissner{at}


    Objective To investigate outcome and course of pregnancies in women with axial spondyloarthritis (axSpA) in a pooled data analysis of pregnancy registries in rheumatology.

    Methods Prospectively followed women with axSpA, fulfilling ASAS classification criteria and for whom a pregnancy outcome was reported, were eligible for the analysis. Anonymised data of four registries was pooled. Rates of adverse pregnancy outcomes were calculated. Systemic inflammation, disease activity and treatment patterns with tumour necrosis factor inhibitor (TNFi) before, during and after pregnancy were analysed.

    Results In a total of 332 pregnancies from 304 axSpA women, 98.8% of the pregnancies resulted in live birth. Mean maternal age was 31 years and disease duration 5 years. Most of these patients received pre-conception counselling (78.4%). Before pregnancy, 53% received TNFi treatment, 27.5% in first and 21.4% in third trimester. Pregnancy and neonatal outcomes were favourable with rates of 2.2% for pre-eclampsia, 4.9% for preterm birth, 3.1% for low birth weight and 9.5% for small for gestational age. Neonates were delivered by caesarean section in 27.7% of pregnancies, of which 47.4% were emergencies. Pooled mean CRP was 4 mg/L before conception peaking in the second trimester at 9.4 mg/L. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was below 4 at all time-points.

    Conclusions Pooled rates of most outcomes were better than what had been reported in the literature and within expected rates of those reported for the general population. Pre-conception counselling, planned pregnancies and a tight management in expert centres applying a tailored treatment approach may have contributed to the favourable pregnancy outcomes.

    • Autoimmune Diseases
    • Epidemiology
    • Spondylitis, Ankylosing
    • Tumor Necrosis Factor Inhibitors
    • Patient Reported Outcome Measures

    Data availability statement

    Data are available upon reasonable request.

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    • Handling editor Josef S Smolen

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    • Correction notice This article has been corrected since it published Online First. The collaborator group has been added to the author list.

    • Collaborators EuNeP collaborator group: Peer Aries, Xenofon Baraliakos, Rakiba Belkhir, Elodie Chauvet, Diana Dan, Juliette Delforge, Azeddine Dellal, Emmanuelle Dernis, Alban Deroux, Nicole Ferreira, Elisabeth Gervais, Cornelia Glaser, Laure Gossec, Jörg Henes, Gabi Kreher, Vincent Langlois, Augustin Latourte, Christian Lavigne, Veronique Le Guern, Hanns-Martin Lorenz, Hubert Marotte, François Maurier, Jacques Morel, Emmanuelle Pannier, Eleftherios Papagiannoulis, Tatjana Rudi, Almut Scherer, Florian Schuch, Raphaele Seror, Nicolas Martin Silva, Thierry Thomas, Marie-Agnès Timsit.

    • Contributors YM, AS, AM, FF, MW, NC-C and RF-B substantially contributed to the conception, the design and the interpretation of this work. AM, FF, MW, NC-C, HB, MC, R-MF, GG-I, IH, BJ, HSSK, CR, JS, AW, AZ and RF-B provided data. YM had full access to all data of this study and takes responsibility for data integrity and accuracy of the analysis. YM drafted the manuscript. All authors substantively revised, read and approved the final manuscript. YM is the guarantor for this study.

    • Funding This work was supported by a research grant from FOREUM Foundation for Research in Rheumatology.

    • Competing interests YM: lecture honoraria from Pfizer outside the scope of the submitted work. AS: speaker fees from AbbVie, Amgen, BMS, Celltrion, Janssen, Lilly, Pfizer, Roche, Sanofi, UCB. AM: consulting fees and symposia: AbbVie, BMS, Janssen, MSD, Pfizer, Biogen, Galapagos, Lilly; research grants: UCB France and Pfizer. FF: Grant/research support from UCB Pharma and GSK; speakers bureau for Mepha, Roche and UCB Pharma. The GR2 study has received grants from patient associations (Lupus France; association des Sclérodermiques de France, association Gougerot Sjögren, AFPCA - Association Francophone contre la Polychondrite chronique atrophiante), from the AFM-Telethon, the French Society of Internal Medicine (SNFMI), the French Society of Rheumatology (SFR), the CMEL commission for Research and Innovation of Cochin Hospital, the Ministère de la Santé (the Clinical REsearch Contract – Database CRCBDD17003), FOREUM (Foundation for Research in Rheumatology), ORRICK society (Price Véronique ROUALET) and an unrestricted grant from UCB (the company had no role in the initiation, planning, conduct, data assembly, analysis or interpretation of the study). IH: consulting fees and symposia: Boehringer Ingelheim, Lilly. CR: consulting fees and symposia: AbbVie, Amgen, Astra Zeneca, BMS, Celltrion, GSK, MSD, Novartis, Pfizer, Biogen, Galapagos, Lilly; research grants: Biogen and Lilly. JS: consulting fees and symposia: AbbVie, BMS, Janssen, MSD, Pfizer, Roche, Sandoz, Fresenius Kabi, Galapagos, Lilly; research grants: Roche France, MSD and Pfizer. The remaining authors have no conflicts of interest to declare.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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