Babies! Safety and Outcomes Data on Pregnancies Save

EULAR Congress 2022 highlighted several posters on pregnancy, an important subject as most rheumatic diseases afflicts women during their childbearing years. I wanted to share with you the ones that caught my eye because they can potentially impact medical practice.

POS1405 "Less than 50% Females with Chronic Rheumatic Inflammatory Diseases Continue a DMARD During Pregnancy: A Descriptive Analysis of the National French Social Security Database”

This is a retrospective cohort study of women who had chronic inflammatory rheumatic diseases (CIRD) from the French Healthcare database covering 98% of the French population. 11,274 patients had a singleton pregnancy during the 10-year study period. The data revealed during pregnancy 42% were not on any disease modifying antirheumatic drugs (DMARD) or corticosteroids (CS); 32% received conventional synthetic DMARD (csDMARD), and 25% a biologic. 30% had exposure to nonsteroidal anti-inflammatory drugs (NSAIDS) during the first trimester with 6% in the second trimester and 2% in the third trimester. Exposure to CS was common, occurring in almost a third of pregnancies even during the third trimester; half the prescriptions filled for CS were for more than 10 milligrams.  It is unclear whether patients on CS declined DMARD therapy, if the treating doctor was unaware of pregnancy compatible DMARD, or if there was a contraindication for patients to receiving one.

POS0705 “Dilemma of Belimumab therapy (dis)continuation during pregnancy: results of a retrospective study in EudraVigilance”

The background to this study is that lupus disease activity, especially lupus nephritis can contribute to adverse pregnancy outcomes. There is paucity of safety data regarding use of belimumab during pregnancy. In this retrospective cohort study of pregnant patients with lupus on belimumab identified through the EudraVigilance database, 47 pregnancies were studied. 37 patients stopped belimumab in the first trimester (Group A); 10 patients continued the medication beyond the first trimester (Group B). The authors found no differences in fetal deaths or gestational age at birth between the two groups; however, higher numbers of congenital malformations, preterm births, low birth weights were seen in Group A (though not statistically significant). Based on the study, the authors concluded that continuation of belimumab might be preferable in patients already on the treatment.

POS0696 “Does Prednisone Use During Pregnancy in Women with Rheumatoid Arthritis Induce Insulin Resistance in the Offspring?”

Exposure to medications during pregnancy may impact the baby in utero and into childhood. This study from the Netherlands examined whether maternal corticosteroid use during rheumatoid arthritis (RA) pregnancy can cause insulin resistance in their offspring through early childhood. 103 children were included; their mothers had participated in the RA pregnancy prospective study. 42 children had in utero exposure to prednisone and 61 were not exposed. The children were assessed for insulin resistance using the Homeostasis Model of Assessment Insulin Resistance (HOMA-IR); serum adiponectin and lipid levels were measured, corrected for body fat distribution. The authors found no difference in the mean HOMA-IR, adiponectin level, body fat distribution, or lipids between the 2 groups through 7 years of age. The study is reassuring for patients who require corticosteroids during pregnancy.

My own conclusions are that 1. We are using too much corticosteroids during pregnancy and underutilizing DMARDS 2. Controlling disease is important during pregnancy as this can have greater impact on pregnancy outcome than medication exposure and 3. If corticosteroids are needed during pregnancy, the child might not develop long term side effects from in utero exposure.