Overview of pregnancy outcomes in the BSRBR
| Group Ia: anti-TNF therapy+MTX or LEF at time of conception | Group Ib: anti-TNF therapy but no MTX or LEF at time of conception | Group II: anti-TNF therapy prior to conception | Group III: never exposed to anti-TNF therapy | |
|---|---|---|---|---|
| Number of women with pregnancy | 20 | 44 | 54 | 10 |
| Number of pregnancies | 21 | 50 | 59 | 10 |
| Single births | 21 | 49 | 58 | 9 |
| Twins | 0 | 1 | 1 | 1 |
| Age, mean (SD) | 29.7 (8.1) | 34.4 (5.2) | 32.6 (4.9) | 32.5 (5.2) |
| Baseline DAS28 score, n/N* | 20/20 | 40/44 | 52/54 | 10/10 |
| Mean (SD) | 6.5 (0.6) | 6.1 (1.2) | 6.0 (1.0) | 5.1 (1.2) |
| Baseline HAQ score, n/N† | 20/20 | 41/44 | 49/54 | 8/10 |
| Mean (SD) | 2.2 (0.4) | 1.9 (0.5) | 1.6 (0.6) | 1.0 (0.4) |
| Diagnosis | ||||
| RA | 16 | 36 | 46 | 10 |
| PsA | 1 | 2 | 1 | 0 |
| JIA | 2 | 4 | 4 | 0 |
| AS | 0 | 2 | 1 | 0 |
| Adult-onset Still's disease | 1 | 0 | 1 | 0 |
| SLE | 0 | 0 | 1 | 0 |
| Anti-TNF therapy at conception | ||||
| Infliximab | 5 | 4 | – | – |
| Etanercept | 12 | 36 | – | – |
| Adalimumab | 4 | 10 | – | – |
| Anti-TNF therapy prior to conception | ||||
| Infliximab (INF) | 4 | 2 | 15 | 0 |
| Etanercept (ETA) | 1 | 1 | 23 | 0 |
| Adalimumab (ADA) | 1 | 0 | 11 | 0 |
| >1 anti-TNF agent | 1 | 2 | 10 | 0 |
| Conventional DMARD use at conception | ||||
| Methotrexate (MTX) | 13 | 0 | 0 | 0 |
| Leflunomide (LEF) | 3 | 0 | 0 | 0 |
| Sulfasalazine (SSZ) | 0 | 1 | 4 | 3 |
| Hydroxychloroquine (HCQ) | 0 | 0 | 1 | 0 |
| Azathioprine (AZA) | 0 | 1 | 2 | 0 |
| IM-gold (iAU) | 0 | 1 | 1 | 0 |
| Combination of DMARDs | 3 (MTX/HCQ) and 2 (MTX/SSZ) | 2 (SSZ/HCQ) | 1 (AZA/SSZ) | 0 |
| Steroid use at conception | 6 (29%) | 17 (34%) | 24 (41%) | 3 (30%) |
| Pregnancy outcome** | ||||
| Live birth | 10 (48%) | 32 (64%) | 46 (78%)‡ | 10 (100%)§ |
| Termination | 4 (19%) | 4 (8%)¶ | 2 (3%) | 0 |
| Spontaneous abortion | 7 (33%) | 12 (24%) | 10 (17%) | 1 (10%) |
| Neonatal death | 0 | 1 (2%) | 0 | 0 |
| Intrauterine death | 0 | 2 (4%)‡ | 2 (3%)‡ | 0 |
| Premature delivery (≤36 weeks) | 3 | 8‡ | 8 | 2 |
↵* DAS28 score significantly higher in the anti-TNF groups compared with the nb-DMARD group. DAS28 significantly higher in group Ia compared with group II (p=0.0213, unpaired t test).
↵** Since the number of outcomes is divided by the number of pregnancies, the total sum of percentages can be more than 100%
↵† HAQ score significantly higher in the anti-TNF groups compared with the nb-DMARD group. HAQ score significantly higher in group Ia compared with group Ib (p=0.0353) and significantly higher in group Ia compared with group II (p<001).
↵‡ Including one of twins.
↵§ Including twins.
↵¶ One because of Down's syndrome.
DAS28, disease activity score in 28 joints; HAQ, Health Assessment Questionnaire; n/N, number of patients with available data/number of women with pregnancy; RA = rheumatoid arthritis; PsA = psoriatic arthritis; JIA = juvenile idiopathic arthritis; AS = ankylosing spondylitis; SLE = Systemic Lupus Erythematosus.