TNF inhibitor use during pregnancy in axial spondyloarthritis: are we asking the right questions?

There is an increasing body of evidence pinpointing disease activity in axial spondyloarthritis as an important factor in determining poor pregnancy outcomes. A systematic review and meta-analysis showed that women with axial spondyloarthritis are at increased risk of adverse pregnancy outcomes, such as preterm birth, caesarean delivery, and low birthweight, compared with women without axial spondyloarthritis, 1 Hamroun S Hamroun A Bigna J-J Allado E Förger F Molto A Fertility and pregnancy outcomes in women with spondyloarthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2022; 61: 1314-1327 Crossref PubMed Scopus (6) Google Scholar and the main factor associated with worse outcomes seemed to be a higher disease activity. A prospective cohort study of women with spondyloarthritis found that higher disease activity during pregnancy was associated with an increased risk of preterm birth. 2 Smith CJF Bandoli G Kavanaugh A Chambers CD Birth outcomes and disease activity during pregnancy in a prospective cohort of women with psoriatic arthritis and ankylosing spondylitis. Arthritis Care Res (Hoboken). 2020; 72: 1029-1037 Crossref PubMed Scopus (32) Google Scholar Temporal trends in adverse pregnancy outcomes in axial spondyloarthritis in Sweden: a cohort studyIn view of remaining concerns regarding safety of the use of biological DMARDs during pregnancy, we saw a reassuring trend in which pregnancy outcomes improved over time in the axial spondyloarthritis group, concurrent with increased use of biological DMARDs. If the current rate of improvement is maintained, women with axial spondyloarthritis treated in accordance with clinical guidelines might eventually not be at an increased risk of adverse pregnancy outcomes. Full-Text PDF