Preconception counseling impact in pregnancy outcomes in patients with spondyloarthritis

Abstract

Introduction: Spondyloarthritis (SpA) is a group of chronic inflammatory diseases, often affecting women in reproductive age, which can have a significant impact on the reproductive health of women. Preconception counselling and medication adjustments have shown to reduce flares and improve pregnancy outcomes in women with rheumatoid arthritis. However, in women with SpA, data of the impact of preconception counselling on pregnancy outcomes is scarce. The aim of this study is to evaluate its impact. Methods: In this retrospective multicentric study, data was collected from medical records of women who gave birth from 2020 to 2022. The study included 45 pregnancies, which were divided into two categories - whether they received preconception consultation or not. Data was collected on patient characteristics, disease duration, medications used, and preconception counselling. Maternal and foetal outcomes were studied. Results: In this study involving 45 patients, radiographic axial spondyloarthritis was the most prevalent type (16 cases), with psoriatic arthritis showing the highest preconception consultation rate (80.0%), with an average of 33.90 years. Lower rates of contraindicated medication were used during pregnancy (0.0%) in counselled patients versus those without counselling (20.0%). Sulfasalazine usage was higher in non-counselled patients (77.8%), while certolizumab pegol use was higher in counselled patients (33.3%). Pregnancy outcomes showed no significant difference in successful pregnancies, but counselled patients experienced significantly fewer postpartum flares (6.4% vs 36.6%). Gestational age at delivery and newborn weight did not significantly differ between groups. Foetal malformation occurred in 2.6% of the population, with no significant difference based on counselling status. Conclusion: Preconception counselling in women with SpA can increase the likelihood of medication adjustments before pregnancy and decrease the occurrence of flares postpartum. These findings suggest that preconception counselling should be implemented in the management of pregnant women with SpA to improve pregnancy outcomes. Further studies are needed to confirm the effectiveness of preconception counselling and to determine the optimal approach.