Spondyloarthritis in pregnancy linked to preterm birth, other adverse outcomes
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Spondyloarthritis in pregnancy is associated with an increased risk for several adverse outcomes, including preterm birth, emergency cesarean section and epidural use, according to data published in Arthritis Care & Research.
“Reduced mobility of the pelvis and spine in women with SpA may lead to malposition of the fetal head with an increased risk of obstructed labor, operative vaginal delivery and delivery by cesarean section as a consequence,” Sofie Mørk, MS, of Odense University Hospital, in Denmark, and colleagues wrote. “These complications, in turn, are associated with increased risk of maternal and neonatal morbidity and mortality. Additionally, the severity of SpA may also adversely affect pregnancy outcomes.”
To examine the prevalence of SpA and its subtypes prior to pregnancy among a nationwide pregnant cohort, as well as to analyze the link between the disease and adverse pregnancy outcomes, Mørk and colleagues used data from the Danish Medical Birth Register (MBR) and the Danish National Patient Registry (NPR). Focusing on a study period of Jan. 1, 1997, to Dec. 31, 2016, the researchers identified 1,220,038 singleton pregnancies in the MBR, of which 1,199,610 pregnancies by 695,563 individuals included complete data on gestational age.
Data on these pregnancies were linked with the NPR, including information on SpA and its related subtypes, including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel diseases and undifferentiated SpA. Exposure was defined as a diagnosis prior to the delivery date. The researchers calculated ORs using logistic regression models, stratified by subtype.
According to the researchers, the overall prevalence of SpA prior to delivery, among the 1,199,610 included pregnancies, was 0.31%, increasing from 0.1% in 1997 to 0.6% in 2016. Pregnant individuals with SpA demonstrated an increased risk for moderately preterm birth (OR = 1.56; 95% CI, 1.33-1.83), very preterm birth (OR = 1.47; 95% CI, 1.042.08), elective cesarean section (OR = 1.44; 95% CI, 1.261.64), emergency cesarean section (OR = 1.17; 95% CI, 1.041.33) and epidural use (OR = 1.11; 95% CI, 1.021.2), compared with those without SpA. These results were comparable across SpA subtypes.
“SpA and all subtypes of the disease diagnosed prior to delivery were associated with increased risk of adverse pregnancy and birth outcomes,” Mørk and colleagues wrote. “Clinician should be aware of this increased risk when consulting women with SpA in their childbearing years. Future research should investigate the pathophysiology of preterm labor in women with SpA and the indications for CS in these women to facilitate development of interventions preventing these outcomes.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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