Pregnancy Outcomes in Autoinflammatory Diseases: Insights from Recent Research

Autoinflammatory diseases primarily affect young individuals, many of whom reach reproductive age and consider pregnancy. These conditions, including familial Mediterranean fever (FMF) and other rare autoinflammatory syndromes, can influence pregnancy, sometimes leading to complications for both mother and fetus. However, comprehensive data on pregnancy outcomes in these patients have been limited. Recent research aims to fill this gap.

The European Alliance of Associations for Rheumatology (EULAR) has updated its guidelines on FMF, emphasizing considerations during pregnancy, but more evidence is necessary. In response, a multicenter prospective cohort study in France observed 97 women with various autoinflammatory diseases, including FMF, undifferentiated systemic autoinflammatory diseases (USAID), TRAPS, CAPS, Still's disease, and others, monitoring disease activity, treatments, and pregnancy outcomes.

Between 2016 and 2024, these women experienced 115 pregnancies, some resulting in twins. Outcomes included five pregnancy terminations before 37 weeks, two fetal in utero deaths, and one spontaneous miscarriage. Notably, over half of the women exhibited disease activity prior to conception, and many experienced flares during pregnancy.

In women with FMF, the median age at disease onset was six years, with pregnancy occurring around age 31. They averaged four flares per year beforehand, with 65.7% experiencing symptoms during pregnancy, such as prolonged febrile syndromes. Pregnancy complications included a preterm delivery risk in twin pregnancies and cases of amnios and oligohydramnios. Overall, 17% of these women delivered before 37 weeks, which is higher than the general population rates in France, and 22.4% of singleton newborns had a low birth weight below the 10th percentile.

Women with USAID had a median disease onset at age 14 and pregnancies around age 30. Many were on colchicine; biologic therapies were often discontinued upon pregnancy detection. Among their infants, only one had a low birth weight. Inflammatory markers like CRP levels were lower in USAID cases compared to FMF, indicating varying disease activity.

The findings highlight the importance of monitoring inflammation closely during pregnancy in women with autoinflammatory diseases. Maintaining good disease control and collaborative care between rheumatologists and obstetricians are crucial for optimal maternal and fetal health.

Source: medicalxpress.com