Rheumatology and Clinical Immunology Unit-ERN ReCONNET, Department of Clinical and Experimental Sciences, ASST Spedali Civili, University of Brescia.
Obstetrics and Gynecology Unit, ASST Spedali Civili, Brescia.
Reumatismo. 2024 Sep 11;76(3). doi: 10.4081/reumatismo.2024.1697.
This review aims to summarize the most recent and updated data on pregnancy in patients with axial spondyloarthritis (axSpA), focusing on the recurrence of pregnancy-related complications, the disease activity throughout gestation and the postpartum, and the latest indications for the treatments of future mothers.
We have conducted a narrative review with an online literature search on Medline and PubMed. We selected only studies written in English published until January 2024, including observational and retrospective studies, meta-analyses, and systematic reviews.
Proper preconception counseling and maternal-fetal monitoring are necessary to ensure the best outcome for both the mother and her baby. Despite the limited and conflicting evidence about the prevalence of adverse pregnancy outcomes in women with axSpA compared to healthy controls, primary findings demonstrate an increased risk of preterm delivery (PTD), low birth weight (LBW), and elective cesarean section (CS). Concerning disease activity, data suggests that 25-80% of women with ankylosing spondylitis experience disease flares during pregnancy, particularly around 20 weeks of gestation. On the contrary, the data on the postpartum disease flare are heterogeneous. The use of biological drugs in pregnancy is safe and effective in controlling disease activity.
Data on pregnancy outcomes in patients with axSpA are scarce and discordant. Probably the difference in maternal disease classification, the evolution of treatment indications, and the differences emerging from study designs can account for these discrepancies. The main evidence shows an increased risk of PTD, LBW, and elective CS (although the latter may reflect cultural influences rather than medical needs due to axSpA itself). The majority of drugs used to treat axSpA, including TNFi, are safe in pregnancy without harming mothers or fetuses. Further data is needed to clarify many controversial aspects in this area.
本综述旨在总结最近和最新的关于轴性脊柱关节炎（axSpA）患者妊娠的数据，重点关注与妊娠相关并发症的复发、整个妊娠和产后期间的疾病活动，以及未来母亲治疗的最新指征。
我们进行了一次在线文献检索的叙事综述，检索了 Medline 和 PubMed。我们仅选择了截至 2024 年 1 月以英文撰写并发表的研究，包括观察性和回顾性研究、荟萃分析和系统评价。
适当的孕前咨询和母婴监测对于确保母婴双方的最佳结局是必要的。尽管与健康对照组相比，axSpA 女性不良妊娠结局的患病率的证据有限且存在争议，但主要研究结果表明早产（PTD）、低出生体重（LBW）和选择性剖宫产（CS）的风险增加。关于疾病活动，数据表明，25-80%的强直性脊柱炎女性在怀孕期间会出现疾病发作，特别是在妊娠 20 周左右。相反，产后疾病发作的数据存在异质性。在怀孕期间使用生物药物在控制疾病活动方面是安全有效的。
axSpA 患者妊娠结局的数据稀少且不一致。可能是由于母亲疾病分类的差异、治疗指征的演变以及研究设计的差异导致了这些差异。主要证据表明 PTD、LBW 和选择性 CS 的风险增加（尽管后者可能反映了文化影响，而不是由于 axSpA 本身的医疗需求）。大多数用于治疗 axSpA 的药物，包括 TNFi，在怀孕期间是安全的，不会对母亲或胎儿造成伤害。需要进一步的数据来阐明该领域的许多有争议的方面。
