Læknablaðið - Jun 2019, Page 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
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Barst til blaðsins 11. febrúar 2019, samþykkt til birtingar 29. apríl 2019.