Fertility and pregnancy outcomes in women with spondyloarthritis: a systematic review and meta-analysis

Objective The aim of this study was to determine the impact of SpA and its treatments on fertility and pregnancy outcomes, as well as the impact of pregnancy on disease activity. Methods A systematic review and meta-analyses were performed, including studies in women with SpA [axial (axSpA) and peripheral SpA, including PsA]. The heterogeneity between studies was quantified (I2), and in the case of substantial heterogeneity, the results were reported in a narrative review. Results Of 4397 eligible studies, 21 articles were included, assessing a total of 3566 patients and 3718 pregnancies, compared with 42 264 controls. There is a lack of data on fertility in the literature. We found an increased risk of preterm birth [pooled odds ratio (OR) 1.64 (1.15–2.33), I2 =24% in axSpA and 1.62 (1.23–2.15), I2 =0.0% in PsA], small for gestational age [pooled OR 2.05 (1.09–3.89), I2 =5.8% in axSpA], preeclampsia [pooled OR 1.59 (1.11–2.27], I2 =0% in axSpA] and caesarean section [pooled OR 1.70 (1.44–2.00), I2 =19.9% in axSpA and 1.71 (1.14–2.55), I2 =74.3% in PsA], without any other unfavourable pregnancy outcome. Further analysis showed a significantly higher risk of elective caesarean section [pooled OR 2.64 (1.92–3.62), I2 =0.0% in axSpA and 1.47 [1.15–1.88], I2 =0,0% in PsA), without increased risk of emergency caesarean section in PsA. During pregnancy, there appears to be a tendency for unchanged or worsened disease activity in axSpA and unchanged or improved disease activity in PsA. Both conditions tend to flare in the postpartum period. Conclusion SpA seems to be associated with an increased risk of preterm birth, small for gestational age, preeclampsia, and caesarean section.