Axial Spondyloarthritis Not Tied to Higher Preeclampsia Risk: Study

Women with psoriatic arthritis 1.85 times more likely to have preeclampsia

Joana Vindeirinho, PhD avatar

by Joana Vindeirinho, PhD |

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Pregnant women with axial spondyloarthritis (AxS) are not at an increased risk of preeclampsia, unlike those with other rheumatic conditions, a new study suggests.

Using more than 3,000 health records, researchers in Sweden and Denmark evaluated preeclampsia risk in pregnant women with rheumatoid arthritis (RA), AxS, and psoriatic arthritis.

“Based on existing evidence and our results, compared with controls, women with [AxS] do not appear to be at substantially increased risk of [preeclampsia],” the researchers wrote.

The study “Risk of pre-eclampsia and impact of disease activity and antirheumatic treatment in women with rheumatoid arthritis, axial spondylarthritis and psoriatic arthritis: a collaborative matched cohort study from Sweden and Denmark,” was published in RMD Open.

AxS is a type of chronic arthritis that mainly affects joints in the spine, pelvis, and chest. Ankylosing spondylitis is a more severe subtype of AxS marked by inflammation of the joints of the spine, particularly those connecting the pelvis with the base of the spine.

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Rheumatic diseases have been associated with adverse pregnancy outcomes, including preterm birth, small baby size, and preeclampsia, a serious condition characterized by high blood pressure and potential organ dysfunction. Developing preeclampsia is related to immune impairment and inflammatory conditions may trigger it.

Although several studies have assessed its risk in pregnant women with rheumatic diseases, evidence on the effect of disease activity and treatment is still lacking, leading a research team in Denmark and Sweden to assess the risk in pregnant women with AxS, psoriatic arthritis, and RA. They measured the risk level in three ways: overall, related to disease treatment, and related to disease activity.

Assessing preeclampsia risk with rheumatic diseases

Researchers used health records of more than 3,000 women — 1,739 with RA, 819 with AxS, and 489 with psoriatic arthritis — who were pregnant between 2006 and 2018. They also collected records of disease activity and anti-rheumatic prescriptions, before and during pregnancy.

Based on anti-rheumatic treatments, patients were analyzed in three groups: no therapy, monotherapy with one class of medications, or combination therapy — at least two oral corticosteroids, conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs), or biological DMARDs.

The pregnancies were compared with more than 30,000 control pregnancies, matched 1:10 on maternal age, number of previous births, and year at birth.

Results showed women with AxS were as likely as their matched controls to have preeclampsia, indicating no increased risk.

In contrast, women with psoriatic arthritis were 1.85 more likely to have preeclampsia than matched control women, a statistically significant increase in risk. Women with RA also had a slight increase in risk compared with matched controls (1.27), but this wasn’t statistically significant.

The researchers then looked at the risk of preeclampsia based on the anti-rheumatic treatment the patients were receiving.

In women with AxS, researchers “found no increased risks of pre-eclampsia when stratifying on treatment, compared with control pregnancies.” With psoriatic arthritis, there was an increased preeclampsia risk when receiving pre-pregnancy monotherapy, while those with RA had an increased risk when receiving pre-pregnancy combination therapy.

Regarding treatment during pregnancy, no statistically significant increased risk was found for any of the disease groups compared with control pregnancies. However, RA women who received combination therapy during pregnancy showed a trend toward an increased risk compared with control pregnancies.

“For RA, maternal combination therapy before and during pregnancy was associated with increased risk,” whereas in psoriatic arthritis “maternal monotherapy before pregnancy was associated with [preeclampsia],” the researchers wrote.

Robust data on disease activity was only available for the RA group where the researchers found that the risk of preeclampsia was higher in those with high disease activity.

“In RA pregnancies with available information (43%), high disease load was associated with doubled risk of [preeclampsia],” they wrote.

The researchers concluded psoriatic arthritis “pregnancies, but not AxSpA pregnancies, were at increased risk of pre-eclampsia. For RA, combination therapy (potentially a surrogate for high disease activity both before and during pregnancy) and high disease load during pregnancy might be a risk factor for [preeclampsia],” they wrote, adding the results offer more security for people with AxS who are or are planning to become pregnant.

“Our findings underline the importance of monitoring disease activity in women with RA and [psoriatic arthritis] before and during pregnancy, especially those with high disease activity and/or anti-rheumatic treatment pre-pregnancy,” they said.