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EULAR Congress 2022 highlighted several posters on pregnancy, an important subject as most rheumatic diseases afflicts women during their childbearing years.
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Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Bad news for digitial ulcers in Systemic sclerosis, Readmissions in Lupus and Thrombocytopenia in APL patients.
Robert B Chao, MD
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Women with spondyloarthritis at increased risk of gestational diabetes, elective and emergency C-sections, and spontaneous pre-term birth. Infants were not more likely to be born SGA.
@RheumNow #EULAR2022 ABST#OP0126 https://t.co/BTXQqruvPs
Robert B Chao, MD
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Study of 2.9k offspring exposed to adalimumab, infliximab, golimumab during pregnancy, as compared to etanercept and certolizumab showed an adjusted hazard ratio for serious infections of 1.20 (CI 0.54, 2.64).
@RheumNow #EULAR2022 ABST#OP0130
Robert B Chao, MD
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Congenital malformations after intra-uterine exposure to non-TNFi when compared to certolizumab showed vedolizumab and belimumab were associated with higher CMs. Vedolizumab showed specific CM pattern (corpus collosum agenesis).
@RheumNow #EULAR2022 ABST#OP0129 https://t.co/wgRlm9QLgW
Md Yuzaiful Md Yusof
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#POS0721 #EULAR2022 Are Aspirin + LMWH enough to prevent Adverse Pregnancy Outcomes (preterm, pregnancy loss, eclampsia) in High Risk Triple Antiphospholipid abs+ve + Low C3/C4? An Italian study of 128 patients said NO. Add Hydroxychloroquine @RheumNow https://t.co/927sZoHZEj
Richard Conway
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Flatman et al. Serious infections in babies born to women using TNFi during pregnancy. 2902 babies. Adjusted HR 1.20 (0.54-2.64) for agents with high vs low placental transfer. @RheumNow #EULAR2022 OP0130 https://t.co/oaW7wDPxva
Richard Conway
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Hamroun @annamolto et al. Factors assoc with increased time to conception in SpA. 56 pregnancies. Multivariate model, age (HR 1.22 (1.08-1.40)) and preconception NSAID use (HR 3.01 (2.15-3.85)) assoc increase time to conception. @RheumNow #EULAR2022 OP0153 https://t.co/y2EAyAdRmk https://t.co/28aLimRInE
TheDaoIndex
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OP0129 Eudravigilance eval pregnancies exposed to non-TNF biologics compared certolizumab. Possible signal w/#vendolizumab: 3 cases of corpus callosum agenesis (2 Crohn’s, 1 UC, 2 assc w/ other CNS malformations). Belim did not show consistent pattern #EULAR2022 @rheumnow https://t.co/BNKaxu6G0c
TheDaoIndex
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No need to switch TNFi during pregnancy. Study compared high placental vs. low placental transfer TNFi- no sig difference for SIE in childhood. Dr. L Flatman comparing different TNFi in pregnancy: 26,000 offsprings #EULAR2022 @rheumnow OP0130 https://t.co/IF5hepQoHc
Aurelie Najm
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Pregnancy outcomes in SpA
Increased risk of
❗️gestational diabetes aRR 1.88
❗️Cesarean delivery aRR 1.54 & 1.23
❗️preterm birth aRR 1.52
❗️trend for increased infection
in 1st year of life in newborns aRR 1.23.
#EULAR2022 @RheumNow OP0126 https://t.co/jMryB5UXQr
Aurelie Najm
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🚨 Study on MTX and male fertility
Analysis of semen parameters in
🙋🏼♂️HC
🙋🏼♂️RA, PsA and PsO MTX naive
🙋🏼♂️Post MTX
Reassuring data as NO significant effect of MTX was observed on several semen parameters.
#EULAR2022 @RheumNow
OP0131 https://t.co/Fq32lzAMAx
TheDaoIndex
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#Belimumab safety in pregnancy
EudraVigilance database retrospect study 47 preg: BEL stopped 1st trimester (group A) vs. cont'd (group B)
- no diff in fetal death
- more preterm birth/low birth weight, congenital malform'n in group A (not stat sig) #EULAR2022 @rheumnow POS0705 https://t.co/sLQ3MHNcWa
Dr. Antoni Chan
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Hamroun S et al for the GR2 Cohort showed that age HR 1.22 and use of NSAIDs HR 3.01 in the pre-conception period was associated with a longer time to conception in women with SpA. Research is needed on continuous NSAID use in the preconception period #EULAR2022 @RheumNow OP0153 https://t.co/hl6jUlK5PN
TheDaoIndex
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GR2 cohort prospective study of pregnancies in 126 pts w/ SpA over 15 years
-Rx exposure 23% steroids, 11% NSAIDS, 55% biologics
- 116 live births, 7 miscarriages, 3 stillbirths
- 36.5% had unfavorable pregnancy outcomes
- 19% SGA
- 4.8% preterm birth
#EULAR2022 @rheumnow POS1000
Md Yuzaiful Md Yusof
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#OP0002 #EULAR2022 What immune tests to monitor during pregnancy in #lupus? A meta-analysis found:
💠32% had a flare (new IS or Pred>9mg/d)
💠⬇️C3 and/or C4 in 1st Trimester predicted LN or SLE flare
Worth checking C3/C4 in each trimester @RheumNow https://t.co/fPEXwReK7u https://t.co/BX6fzKzfvC
Dr. John Cush
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Retrospective pregnancy outcome study in 154 Rheumatic pts. Systemic sclerosis pts had higher risk of adverse preg outcomes (vs HC - 60.6% vs 10.0%; OR = 14; SSc had increase in 1st trimester miscarriage, preeclampsia, SGA & Preterm https://t.co/hfd6SsCRmr
Conclusions
Dr. John Cush
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Watch: Pregnancy Paradox: How Stopping Drugs Leads to Greater Harm
Uma Mahadevan, MD talks about the pregnancy paradox and how stopping medications in pregnancy to protect the fetus can actually lead to greater harm.
https://t.co/HYO5BdjwzZ https://t.co/IGeZ3O8Dno
Dr. John Cush
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Three (3) Worst Drugs to use in #Lupus patients who want to be pregnant (MTX, MMF, CTX) #UTSWSLE2022 https://t.co/YBeLTuRLO1
Dr. John Cush
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Algorithmic approach to SLE and assessing/treating early pregnancy. #UTSWSLE2022 https://t.co/692el4R9sZ
