Birth Outcomes and Disease Activity During Pregnancy in a Prospective Cohort of Women With Psoriatic Arthritis and Ankylosing Spondylitis

Objective To add to data on adverse birth outcomes accounting for disease activity in women with psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Methods Data were analyzed from women enrolled in the Organization of Teratology Information Specialists Autoimmune Disease Project from 2004 to 2018. Disease activity was measured according to the Health Assessment Questionnaire (HAQ) or Routine Assessment of Patient Index Data 3 (RAPID3) scores. Poisson regression was used to estimate adjusted risk ratios (ARRs) with 95% confidence intervals (95% CIs) for selected adverse pregnancy outcomes. Results Compared to healthy controls (n = 717), women with PsA (n = 117) were at increased risk for moderate preterm delivery (32–36 weeks’ gestation) (ARR 1.81, 95% CI 1.01–3.26), oligohydramnios (ARR 3.79, 95% CI 1.34–10.74), and cesarean delivery (ARR 1.63, 95% CI 1.26–2.12). Women with AS (n = 129) had an increased risk of delivering infants requiring intensive care (ARR 1.67, 95% CI 1.05–2.67). A high HAQ score at 32 weeks was associated with preterm delivery in women with PsA (ARR 3.82, 95% CI 1.51–9.67). In women with AS, a high RAPID3 score was associated with cesarean delivery (ARR 5.82, 95% 1.06–31.78), and second trimester glucocorticoid use was associated with preterm delivery (ARR 4.41, 95% CI 1.57–12.41). Conclusion Women with PsA and AS have increased risk for selected adverse pregnancy outcomes. Active disease and use of glucocorticoids may increase the risk for some adverse pregnancy outcomes in women with these conditions.