J Korean Med Sci.  2023 Jun;38(22):e172. 10.3346/jkms.2023.38.e172.

Pregnancy Outcomes Associated With Biologic Agent Exposure in Patients With Several Rheumatic Diseases and Inflammatory Bowel Diseases

• Ahn SM
• Joo YB
• Kim YJ
• Bang SY
• Lee HS

• KMID: 2542804
• DOI: http://doi.org/10.3346/jkms.2023.38.e172

Abstract

Background
This study aimed to analyze pregnancy outcomes based on biologic agents use in women using the nationwide population-based database.
Methods
The study used the claims database to identify women of childbearing age with several rheumatic (rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis) and inflammatory bowel diseases (Crohn’s disease and ulcerative colitis) who had pregnancy-related codes between January 2010 and December 2019. We analyzed live births and adverse pregnancy outcomes based on the previous use of biologics. We also stratified the patients according to duration of biologic agent exposure before pregnancy and the use of biologics during pregnancy to analyze the pregnancy outcomes by subgroups.
Results
We identified 4,787 patients with pregnancy events. Among them, 1,034 (21.6%) used biologics before pregnancy. Live birth rate was not different between the biologics group and biologics naïve group (75.0% vs. 75.2%). Multivariate analyses showed that biologics use was associated with higher risk of intrauterine growth retardation (odds ratio [OR], 1.780) and lower risk of gestational diabetes mellitus (OR, 0.776) compared with biologics naïve. Biologics use during pregnancy was associated with higher risk of preterm delivery (OR, 1.859), preeclampsia/eclampsia (OR, 1.762), intrauterine growth retardation (OR, 3.487), and cesarean section (OR, 1.831), but lower risk of fetal loss (OR, 0.274) compared with biologics naïve.
Conclusions
Although there was no difference in live birth rate between the biologics group and biologics naïve group, biologics use seems to be associated with several adverse pregnancy outcomes, especially in patients with biologics during pregnancy. Therefore, patients with biologics during pregnancy need to be carefully observed for adverse pregnancy outcomes.

Keyword

Biologics; Pregnancy; Rheumatoid Arthritis; Ankylosing Spondylitis; Psoriatic Arthritis; Inflammatory Bowel Diseases

Figure

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  Fig. 1 Flow diagram of the study population.AS = ankylosing spondylitis, CD = Crohn’s disease, JIA = juvenile idiopathic arthritis, NHIS = National Health Insurance Service, PsA = psoriatic arthritis, RA = rheumatoid arthritis, UC = ulcerative colitis.

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