Pregnancy outcomes in patients with axial spondyloarthritis: a UK-based survey

Objectives To explore pregnancy outcomes in patients with axial spondyloarthritis (axSpA) in the United Kingdom (UK). Methods A patient-reported online survey, based on the EULAR core data set for pregnancy registries in rheumatology, was conducted via the REDCap platform with data included between October 2022 and October 2023. Data were analysed descriptively. Results A total of 139 pregnancies from 89 women following a diagnosis of axSpA were analysed. The mean age at pregnancy was 32.1 years (SD 4.3), at diagnosis was 27.6 years (SD 5.1), and at symptom onset was 20.8 years (SD 5.8). Most pregnancies were planned (90.6%), and achieved by natural conception (90.2%) with 68.3% conceiving within one year. Assisted conception was reported infrequently. Pre-pregnancy concerns such as pain levels increasing (74.8%), birth complications (62.6%) and passing on axSpA to a child (63.3%) were frequently reported. Flares occurred during 33.6% of pregnancies and in over half (55.6%) during postpartum. The live birth rate was 76.4%. Rates of pre-eclampsia and congenital anomalies were 5.4% and 9.5%, respectively. Caesarean section occurred in 53.8% of pregnancies, with active disease and patient choice core reasons. Most infants received vaccinations as scheduled (83.5%). AxSpA did not affect decision to breastfeed for 82.6% of pregnancies, but it did affect perceived ability to care for the baby in the first 6 months (61.3%). Conclusion Many women with axSpA experience increased time to pregnancy, disease-related pre-pregnancy worries, flares and delivery via caesarean section. Pre-pregnancy counselling may be important for women with axSpA of reproductive age.