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Pregnancy in axial spondyloarthropathy: A systematic review & meta-analysis

Author

Semin Arthritis Rheum. 2020 Dec;50(6):1269-1279.doi: 10.1016/j.semarthrit.2020.08.011. Epub 2020 Aug 29.

Sinead Maguire 1Tom O'Dwyer 2David Mockler 3Finbar O'Shea 4Fiona Wilson 5

Author Information

1 Department of Rheumatology, St James' Hospital, James' Street, Dublin, Ireland. Electronic address: sinead.magu@gmail.com.

2 Independent Researcher, Dublin, Ireland.

3 John Stearne Medical Library, Trinity College Dublin, Dublin, Ireland.

4 Department of Rheumatology, St James' Hospital, James' Street, Dublin, Ireland.

5 Discipline of Physiotherapy, Trinity College, Dublin, Ireland.

Abstract

Background: Axial spondyloarthropathy (axSpA) is an inflammatory arthritis which affects the sacroiliac joints and the spine. Many females affected are of childbearing age. Studies on effects of pregnancy on axSpA disease activity and medication use have been limited, with divergent conclusions.

Objective: To review literature on axSpA in pregnancy to determine the effect of disease on pregnancy outcomes.

Methods: A systematic review of case-control trials, observational studies, cross sectional studies and case series (n>5) on axSpA in pregnancy. EMBASE, Medline (OVID), CINAHL, Maternity and Infant Care (MIDIRS online), and Web of Science were searched for keywords. Two reviewers reviewed articles to determine suitability for inclusion. The Newcastle Ottawa Scale was used to assess risk of bias. Data extraction was performed using a standardized template to streamline data to allow comparison and meta-analysis.

Results: Search strategy returned 884 records, 130 full text articles were assessed for eligibility. Eighteen studies with a total of 3,166 axSpA participants were eligible for inclusion. There was an increased prevalence of pre-eclampsia (OR 1.3, 95% CI 0.92-1.82) and IUGR (OR 1.17, 95% CI 0.26-5.17) and a statistically significant increase in cesarean sections (OR 1.85, 95% CI 1.46-2.30) in axSpA females, with an especially high prevalence of elective cesarean sections (OR 2.26, 95% CI 1.74, 2.93). There was a trend towards increased prevalence of fetal complications in axSpA pregnancies (LBW OR 1.47, 95% CI 0.98-2.21; SGA OR1.66, 95% CI 0.93-2.95; congenital abnormalities OR 1.34, 95% CI0.63-1.24; NICU admissions OR 1.55, 95% CI 0.96-2.51) which did not reach significance.

Conclusion: AxSpA females have an increased prevalence of cesarean sections compared to the general population. There is a trend towards increased prevalence of pre-eclampsia, IUGR and certain fetal complications. Ongoing development of national registries could help to better understand axSpA in pregnancy.