Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
Department of Perinatology and Gynecology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Clin Rheumatol. 2019 May;38(5):1453-1458. doi: 10.1007/s10067-019-04450-3. Epub 2019 Feb 7.
We examined the effect of biologic disease-modifying anti-rheumatic drugs on the time to pregnancy in patients with rheumatoid arthritis who hope to become mothers. Additionally, we evaluated adverse pregnancy outcomes and risk factors of these drugs.
We retrospectively investigated 25 pregnancies of 19 patients who were taking disease-modifying anti-rheumatic drugs. In 15 pregnancies, patients continued biologic disease-modifying anti-rheumatic drugs until conception (group A). In 10 pregnancies, patients discontinued biologic disease-modifying anti-rheumatic drugs and conventional synthetic disease-modifying anti-rheumatic drugs at the time of planning to conceive (group B). We used tumor necrosis factor inhibitors (certolizumab pegol and etanercept) for group A patients.
The mean time to pregnancy was shorter in group A than in group B (5.9 ± 3.8 vs 11.0 ± 6.5 months, P = 0.04). The mean birth weight of newborns was lighter in group B than in group A (2446.5 ± 352.4 vs 2969.4 ± 459.9 g, P = 0.007). There were no significant differences in the rates of preterm birth, light-for-date, and premature rupture of the membranes between the groups. In patients with preterm birth or light-for-date newborns, the mean dose of corticosteroids during pregnancy was significantly higher compared with that in those with full-term birth or non-light-for-date newborns (P = 0.02, P < 0.01, respectively).
In patients with rheumatoid arthritis who hope to conceive, continuing biologic disease-modifying anti-rheumatic drugs at the time of conception could shorten the time to pregnancy. Using biologic disease-modifying anti-rheumatic drugs before pregnancy does not affect abortion, preterm birth, light-for-date, and premature rupture of the membranes.
我们研究了生物改善病情抗风湿药物对希望成为母亲的类风湿关节炎患者妊娠时间的影响。此外，我们还评估了这些药物的不良妊娠结局和危险因素。
我们回顾性调查了 19 名正在服用改善病情抗风湿药物的患者的 25 例妊娠。在 15 例妊娠中，患者在受孕时继续使用生物改善病情抗风湿药物（A 组）。在 10 例妊娠中，患者在计划受孕时停止使用生物改善病情抗风湿药物和传统合成改善病情抗风湿药物（B 组）。A 组患者使用肿瘤坏死因子抑制剂（依那西普和培塞利珠单抗）。
A 组的妊娠时间明显短于 B 组（5.9±3.8 与 11.0±6.5 个月，P=0.04）。B 组新生儿的平均出生体重明显轻于 A 组（2446.5±352.4 与 2969.4±459.9 克，P=0.007）。两组早产儿、小样儿和胎膜早破的发生率无显著差异。在早产或小样儿的患者中，妊娠期间皮质激素的平均剂量明显高于足月分娩或非小样儿的患者（P=0.02，P<0.01）。
对于希望怀孕的类风湿关节炎患者，在受孕时继续使用生物改善病情抗风湿药物可以缩短妊娠时间。在怀孕前使用生物改善病情抗风湿药物不会影响流产、早产、小样儿和胎膜早破。
