Læknablaðið - jún. 2019, Blaðsíða 19

LÆKNAblaðið 2019/105 275
R A N N S Ó K N
Signý Rut Kristjánsdóttir1
Þóra Steingrímsdóttir1,2
Gerður Gröndal3,4
Ragnheiður I. Bjarnadóttir2,5
Kristjana Einarsdóttir6
Björn Guðbjörnsson1,4 on behalf of ICEBIO
Introduction: To collect nationwide data in Iceland on pregnancy
and its outcomes among female patients with active inflammatory
arthritides we linked two registers, the ICEBIO register and the Ice-
landic Medical Birth Register.
Methods: We used multivariate analysis to evaluate the risk of pre-
term birth, Caesarean section, low Apgar score at 5-minutes and
low birth weight among females with inflammatory arthritis (rheuma-
toid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis
(AS)) in comparison with healthy controls matched on age and par-
ity. We also investigated pregnancies before and after the diagnosis
of respective rheumatic disease and especially in respect to treat-
ment with TNFα inhibitors (TNFi).
Results: In the end of 2016, 723 female patients were registered in
ICEBIO as they had received treatment with TNFi due to inflamma-
tory arthritis. Of those, 412 women had given birth to 801 children,
whereof 597 were delivered before confirmed diagnosis of the
mother and 53 were delivered after the start of the TNFi treatment.
Relative risk of Caesarean section among these female with vari-
ous arthritis conditions were 1.47 (95% CI: 1.19-1.82; p < 0,001)
compared to controls and was highest in the group with PsA or
2.06 (1.41-3.02; p<0,001). We did not find increased risk of preterm
delivery or low Apgar score. Patients with inflammatory arthritis
had lower risk of children with low birth weight or 0.37 compared to
healthy controls (95% CI: 0.36-0.37; p < 0.05). Due to low numbers
of deliveries after the initiation of TNFi therapy (n=53) we were not
able to perform any analysis for that group.
Conclusion: Icelandic female patients with inflammatory arthritis
are at an increased risk of Caesarean section in comparison to
healthy controls. However, their newborns are in good condition and
healthy at birth. Analysis of the impact of treatment with TNFi on
pregnancy is not yet possible due to limited data.
Pregnancy outcomes in Icelandic female patients with inflammatory arthritides.
Nationwide results from the ICEBIO and the Icelandic Medical Birth Register
ENGLISH SUMMARY
1Faculty of Medicine and 6Centre of Public Health Sciences, University of Iceland. 2Department of Obstetrics and Gynecology, 3Department of Rheumatology and 4Centre for
Rheumatology Research, Landspitali University Hospitaland 5Health Care of the Capital Area, Reykjavik Iceland
Key words: Ankylosing spondylitis, ICEBIO, pregnancy outcome, psoriatic arthritis, rheumatoid arthritis, TNFα inhibitor.
Correspondence: Björn Guðbjörnsson, bjorngu@landspitali.is
1. Geirsson AJ, Eyjolfsdottir H, Bjornsdottir G, Kristjansson
K, Gudbjornsson B. Prevalence and clinical characteristics
of ankylosing spondylitis in Iceland ­ a nationwide study.
Clin Exp Rheumatol 2010; 28: 333­40.
2. Love TJ, Gudbjornsson B, Gudjonsson JE, Valdimarsson
H. Psoriatic arthritis in Reykjavik, Iceland: prevalence,
demographics, and disease course. J Rheumatol 2007; 34:
2082­8.
3. Englund M, Jöud A, Geborek P, Felson DT, Jacobsson LT,
Petersson IF. Prevalence and incidence of rheumatoid
arthritis in southern Sweden 2008 and their relation to
prescribed biologics. Rheumatology 2010; 49: 1563­9.
4. Ince­Askan H, Dolhain RJ. Pregnancy and rheumatoid
arthritis. Best Pract Res Clin Rheumatol 2015; 29: 580­96.
5. Østensen M, Cetin I. Autoimmune connective tissue disea­
ses. Best Pract Res Clin Obstet Gynaecol 2015; 29: 658­70.
6. Williams M, Chakravarty EF. Rheumatoid arthritis and
pregnancy: impediments to optimal management of both
biologic use before, during and after pregnancy. Curr
Opin Rheumatol 2014; 26: 341­6.
7. Østensen M, Villiger PM, Förger F. Interaction of pregn­
ancy and autoimmune rheumatic disease. Autoimmun
Rev 2012; 11: A437­A46.
8. Argilés JM, Carbó N, López­Soriano FJ. TNF and pregn­
ancy: the paradigm of a complex interaction. Cytokine
Growth Factor Rev 1997; 8: 181­8.
9. Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ,
Koldingsnes W, Mikkelsen K, et al. Postpartum onset of
rheumatoid arthritis and other chronic arthritides: results
from a patient register linked to a medical birth registry.
Ann Rheum Dis 2010; 69: 332­6.
10. Komaki F, Komaki Y, Micic D, Ido A, Sakuraba A.
Outcome of pregnancy and neonatal complications with
anti-tumor­necrosis­factor-α­use­in­females­with­immune­
mediated diseases; a systematic review and meta­analysis.
J Autoimmun 2017; 76:3 8­52.
11. Björgúlfsson Þ, Gröndal G, Blöndal Þ, Guðbjörnsson
B. Skimun fyrir berklum meðal gigtarsjúklinga sem
hófu­ meðferð­ með­ TNFα-hemlum­ á­ Íslandi­ 1999-2014.­
Læknablaðið 2018; 104: 231­35.
12. Guðbjornsson B. ICEBIO ­ kerfisbundin meðferðarskrán­
ing. Gigtin 2009; 2: 9­12.
13.­ Embætti­ landlæknis.­ Fæðingaskrá.­ landlaeknir.is/tol­
fraedi-og-rannsoknir/gagnasofn/gagnasafn/item12340/
Fadingaskra ­ júní 2016.
14. Østensen M, Andreoli L, Brucato A, Cetin I, Chambers
C, Clowse MEB, et al. State of the art: Reproduction and
pregnancy in rheumatic diseases. Autoimmn Rev 2015; 14:
376­86.
15. Brouwer J, Hazes JMW, Laven JSE, Dolhain RJEM.
Fertility in women with rheumatoid arthritis: influence of
disease activity and medication. Ann Rheum Dis 2015; 74:
1836­41.
16. Hagstofa Íslands. Frjósemi og fólksfjölgunarhlutfall
1853-2016.­ px.hagstofa.is/pxis/pxweb/is/Ibuar/Ibuar__
Faeddirdanir__Faeddir__faedingar/MAN05202.px/?rx­
id=0bfa37d0­4a44­4cf1­950b­898b26520b78.
17. Nørgaard M, Larsson H, Pedersen L, Granath F, Askling J,
Kieler H, et al. Rheumatoid arthritis and birth outcomes:
a Danish and Swedish nationwide prevalence study. J Int
Med 2010; 268: 329­37.
18. van der Heijde D, Ramiro S, Landewé R, Baraliakos X,
Van den Bosch F, Sepriano A, et al. 2016 update of the
ASAS­EULAR management recommendations for axial
spondyloarthritis. Ann Rheum Dis 2017; 76: 978­91.
19. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT,
Bingham CO, et al. 2010 Rheumatoid arthritis classification
criteria:­An­American­College­of­Rheumatology/European­
League Against Rheumatism collaborative initiative.
Arthritis Rheum 2010; 62: 2569­81.
20. Jakobsson GL, Stephansson O, Askling J, Jacobsson
LTH. Pregnancy outcomes in patients with ankylosing
spondylitis: a nationwide register study. Ann Rheum Dis
2016; 75: 1838­42.
21. Langen ES, Chakravarty EF, Liaquat M, El­Sayed YY,
Druzin ML. High rate of preterm birth in pregnancies
complicated by rheumatoid arthritis. Am J Perinatol 2014;
31: 9­14.
22. Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ,
Nordvåg BY, Koldingsnes W, et al. Pregnancy and deli­
very in women with chronic inflammatory arthritides
with a specific focus on first birth. Arthritis Rheum 2011;
63: 1534­42.
23. Embætti landlæknis. Skýrsla Fæðingaskrár fyrir árið 2015.
Reykjavík 2017.
24. Reed SD, Vollan TA, Svec MA. Pregnancy outcomes in
women with rheumatoid arthritis in Washington State.
Matern Child Health J 2006; 10: 361­6.
25. Clowse MEB, Scheuerle AE, Chambers C, Afzali
A, Kimball AB, Cush JJ, et al. Pregnancy outcomes after
exposure to certolizumab pegol updated results from a
pharmacovigilance safety database. Arthritis Rheum 2018;
70: 1399­407.
26. Rekommendationer avseende anti­inflammator­
isk och immun­modulerande behandling i samband
med­ graviditet­ och­ amning.­ svenskreumatologi.se/
wp-content/uploads/2019/03/graviditet-och-amning_rikt­
linjedokument-graviditet-_amning-2019.pdf­­-­apríl­2019.
Heimildir
Barst til blaðsins 11. febrúar 2019, samþykkt til birtingar 29. apríl 2019.