Pregnancy Outcomes in Autoinflammatory Disease

Autoinflammatory Disease: Autoinflammatory diseases predominantly affect young patients, many of whom may go on to become pregnant. For many inflammatory diseases, pregnancy can be a period of destabilisation of inflammatory activity, and may lead to complications for the mother or foetus. But there is a lack of prospective large cohort data on pregnancy outcomes in these patients – particularly in familial Mediterranean fever (FMF).^1-3 EULAR – The European Alliance of Associations for Rheumatology – has recently issued updated recommendations on FMF that take pregnancy into account,⁴ but more information is needed.

To address this, a French multi-centre prospective pregnancy observational cohort was set up, to analyse disease activity, treatment, pregnancy outcomes, delivery, and neonatal health. The work – presented at the 2025 annual congress of EULAR – showcased findings from 97 women with an autoinflammatory disease. The most common diagnoses were FMF (81%), followed by undifferentiated systemic autoinflammatory diseases (USAID), tumour necrosis factor receptor-associated periodic syndrome (TRAPS), cryopyrin-associated periodic syndromes (CAPS), Still's disease, recurrent pericarditis, mevalonate kinase deficiency, A20 haploinsufficiency, and other rare diseases.

Over a period from 2016 to 2024, the 97 women studied carried 115 pregnancies, including five sets of twins. Sixteen pregnancies were terminated before the 37th week of gestation, including two foetal deaths in utero, two therapeutic abortions due to chromosomal abnormalities, and one spontaneous abortion. In the year prior to pregnancy, 57.7% of women had signs of disease activity, and 59.1% experienced flares during their pregnancy.

In women with FMF, the median age at onset was 6 years, and they were 31 when they got pregnant – with 15% needing assisted reproduction. They reported a mean of four disease flares per year in the year prior to pregnancy. Inflammatory symptoms during pregnancy happened in 65.7% of cases, including 3 prolonged febrile myalgia syndromes. Pregnancy complications included one risk of preterm delivery in a twin pregnancy; one patient experienced one anamnios and one oligohydramnios during both of her pregnancies. Overall, 17% of women delivered their baby before 37 weeks – higher than the 7% expected in the general population for France – and 22.4% of singleton babies had a birth weight below the 10th percentile, again compared to only 7.1% in the general population.

In women with USAID, the median age at disease onset was 14, and they were 30 when they got pregnant. Half were receiving colchicine, and biologic therapy was discontinued in 2 women upon discovery of pregnancy. Of the newborns, only one had a birth weight less than the 10th percentile. When looking at markers of inflammation, the group found that women with USAID had mean CRP at enrolment of 8.9 mg/dL, compared to 22.5 mg/dL for women with FMF.

Also Read: https://www.medboundtimes.com/fitness-and-wellness/labor-induction-doesnt-always-reduce-caesarean-birth-risk-or-improve-outcomes-for-term-pregnancies

Presenting the study in Barcelona, Léa Savey said “this demonstrates the importance of monitoring inflammation during pregnancy in women with autoinflammatory diseases, and supports the need for close collaboration between the physician managing the underlying autoinflammatory disease and the obstetrician”. This means good control of disease and the ability to continue treatment. AlphaGalileo/SP