Available online 29 August 2023, 101868

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Limited research has been conducted on the impact of spondylitis (SpA) on fertility, but some studies suggest a higher risk of subfertility in women with SpA compared to the general population. Factors associated with impaired fertility in SpA include pain, fatigue, stiffness, functional disorders, depression, anxiety, negative body image, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) preconceptionally, while TNF alpha inhibitors may play a role in improving fertility in certain cases.

There has been a recent increase in clinical research focused on pregnancy outcomes in SpA. However, clear trends in terms of risk of pregnancy and fetal complications have been slow to emerge and many questions remain for women with SpA planning a pregnancy. This article discusses the current evidence for risk of specific pregnancy and fetal complications in women with axial and psoriatic SpA.

Section snippetsFertility and counseling

Spondyloarthritis (SpA) is the second most prevalent chronic rheumatic inflammatory disease, and it affects particularly individuals of childbearing age [1]. Disease has a significant impact on patient's quality of life, causing pain, stiffness, and disability during their reproductive years, and it is, therefore, crucial to address the issue of pregnancy wish and discuss the possible treatment adaptations to set in place in this context. While impaired fertility and ovarian dysfunction have

Outcomes in axial spondyloarthritis

Symptom onset in axial spondyloarthritis (axSpA) is typically in the third decade of life or the twenties, which for women is a critical time in their childbearing years [24]. As such, many women with axSpA will be aware of their diagnosis prior to their pregnancy. Although there has been copious research focused on pregnancy outcomes in other forms of rheumatic and musculoskeletal diseases (RMDs), such as rheumatoid arthritis [9] and systemic lupus erythematosus [25], the literature on

Neonatal outcomes in SpA

While there has been a dramatic increase in studies capturing outcomes in pregnancies of women with SpA over recent years, data on neonatal outcomes has been slower to emerge. There are many reasons for this including a high level of heterogeneity of specific neonatal outcomes captured, lack of dedicated neonatal outcome studies in women with SpA, and relative rarity of certain neonatal outcomes resulting in studies being underpowered to detect significant differences.

Summary

Managing the preconception period in clinical practice for patients with spondylitis involves early planning and addressing pregnancy wishes with patients. Preconception consultations should be dedicated to assessing disease remission, educating patients about the impact of disease activity and treatments on fertility and pregnancy, checking supplementations, and discussing the management plan for the preconception and pregnancy periods. Implementing such an approach should improve the

Declaration of competing interest

None.

References (72)T.M. Luu et al.Long-term impact of preterm birth: neurodevelopmental and physical health outcomes

Clin Perinatol

(2017)

H.A. Frey et al.The epidemiology, etiology, and costs of preterm birth

Semin Fetal Neonatal Med

(2016)

S. Maguire et al.Pregnancy in axial spondyloarthropathy: a systematic review & meta-analysis

Semin Arthritis Rheum

(2020)

M. Morin et al.Temporal trends in adverse pregnancy outcomes in axial spondyloarthritis in Sweden: a cohort study

The Lancet Rheumatology

(2023)

E. Jung et al.The etiology of preeclampsia

Am J Obstet Gynecol

(2022)

J. Sandall et al.Short-term and long-term effects of caesarean section on the health of women and children

Lancet

(2018)

C. Valdeyron et al.Impact of disease activity and treatments on ovarian reserve in patients with rheumatoid arthritis in the ESPOIR cohort

Rheumatology (Oxford)

(2021)

J. Brouwer et al.Levels of serum anti-Müllerian hormone, a marker for ovarian reserve, in women with rheumatoid arthritis

Arthritis Care Res (Hoboken)

(2013)

X.H. Zhang et al.Assessment of the ovarian reserve by serum anti-müllerian hormone in rheumatoid arthritis patients: a systematic review and meta-analysis

Int Arch Allergy Immunol

(2022)

S. Hamroun et al.Fertility and pregnancy outcomes in women with spondyloarthritis: a systematic review and meta-analysis

Rheumatology (Oxford)

(2022)

WHO. Infertility definitions and terminology

(2017)

K. Ursin et al.Factors associated with time to pregnancy in women with axial spondyloarthritis: a registry-based multicenter study

Arthritis Care Res (Hoboken).

(2021)

S. Hamroun et al.OP0153 preconceptional NSAID treatment is associated with longer time-to-conception in women with spondyloarthritis: analysis of the prospective GR2 cohort

Ann Rheum Dis

(2022)

J. Brouwer et al.Fertility in women with rheumatoid arthritis: influence of disease activity and medication

Ann Rheum Dis

(2015)

K.A. McInerney et al.Preconception use of pain-relievers and time-to-pregnancy: a prospective cohort study

Hum Reprod

(2017)

L.L. Mendonça et al.Non-steroidal anti-inflammatory drugs as a possible cause for reversible infertility

Rheumatology (Oxford)

(2000)

M.C. Micu et al.Luteinized unruptured follicle syndrome increased by inactive disease and selective cyclooxygenase 2 inhibitors in women with inflammatory arthropathies

Arthritis Care Res (Hoboken)

(2011)

M. Pall et al.Induction of delayed follicular rupture in the human by the selective COX-2 inhibitor rofecoxib: a randomized double-blind study

Hum Reprod

(2001)

S.S. Agrawal et al.Anti-implantation activity of H2 receptor blockers and meloxicam, a COX-inhibitor, in albino Wistar rats

Eur J Contracept Reprod Health Care

(2009)

A. Wanders et al.Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial

Arthritis Rheum

(2005)

K. Adams et al.Safety and efficacy of on-demand versus continuous use of nonsteroidal antiinflammatory drugs in patients with inflammatory arthritis: a systematic literature review

J Rheumatol Suppl

(2012)

M. Dougados et al.Nonsteroidal antiinflammatory drug intake according to the Assessment of SpondyloArthritis International Society Score in clinical trials evaluating tumor necrosis factor blockers: example of etanercept in advanced ankylosing spondylitis

Arthritis Care Res (Hoboken)

(2012)

E.E. Winger et al.Treatment with adalimumab (Humira) and intravenous immunoglobulin improves pregnancy rates in women undergoing IVF

Am J Reprod Immunol

(2009)

Y. Meissner et al.Pregnancy and neonatal outcomes in women with axial spondyloarthritis: pooled data analysis from the European Network of Pregnancy Registries in Rheumatology (EuNeP)

Ann Rheum Dis

(2022)

L.R. Sammaritano et al.2020 American college of rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases

Arthritis Rheumatol

(2020)

X. Mariette et al.Lack of placental transfer of certolizumab pegol during pregnancy: results from CRIB, a prospective, postmarketing, pharmacokinetic study

Ann Rheum Dis

(2018)

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