THU0144 DESCRIPTIVE ANALYSIS OF PREGNANCY, DELIVERY, AND LACTATION IN PATIENTS WITH RHEUMATOID ARTHRITIS FROM THE IORRA COHORT.

Abstract

Background:Rheumatoid Arthritis (RA) is common in women with reproductive age. For this reason, RA treatment during pregnancy and lactation is very important. In recent years, the use of biologic disease-modifying antirheumatic drugs (bDMARDs) has become common in RA treatment (1), treatment during pregnancy and lactation has changed drastically (2,3).Objectives:To investigate the pregnancy, delivery and lactation status of RA patients and treatment during that period in daily practice.Methods:The IORRA cohort is a large, single institute-based, observational cohort of RA patients established at Institute of Rheumatology, Tokyo Women’s Medical University, in 2000. We identified female RA patients aged 20-49 years who answered ‘pregnant’ or ‘delivered’ in the IORRA survey in 2010-2016 and whose pregnancies were confirmed in the medical records. We examined the Disease Activity Score with 28 joint count (DAS28)-CRP, medication use situation, the outcome of pregnancy, and lactation in those patients.Results:A total of 101 patients and 143 pregnancies were confirmed, of which 136 outcomes of pregnancy could be confirmed in the medical records. Among 136 confirmed pregnancy cases, there were 106 births and 30 miscarriages. Among 106 births, 4 cases (3.8%) were birth defects that could be confirmed in the medical records. The average age at pregnancy was 34.2±3.7 years and 36.1±3.3 years in delivered and miscarried cases, respectively. Miscarried cases were significantly older pregnancies (p=0.01). Of the 106 births, 65 birth weeks were confirmed, with an average of 37.9±1.8 weeks. The number of preterm delivery was 11 cases (16.9%). The average birth weight of 59 babies whose birth weight could be confirmed was 2699±517 g. There were 21 cases (35.6%) of low birth weight infants. The proportion of patients in DAS28-CRP remission was 73.1% before pregnancy, 61.6% during pregnancy, and 68.0% 1 year after delivery. Drugs used before pregnancy were glucocorticoid (48.8%), non-steroidal anti-inflammatory drugs (14.2%), conventional synthetic DMARDs (24.8%), and bDMARDs (48.0%). Etanercept accounted for 90% of bDMARDs. Among taking bDMARDs patients, 73.8% were discontinued after the pregnancy, and 26.2% were continued during pregnancy. Among those patients who continued bDMARDs, lactating patients were 12/26 (46.2%) cases after delivery, 10/30 (33.3%) cases in six months after delivery, and 7/36 (19.4%) cases in 1 year after delivery, respectively.Conclusion:The actual situation of pregnancy, delivery, and lactation in RA patients was revealed. Especially, bDMARDs were used at relatively high rates in RA patients who wish to have a child.