Spondyloarthritis in the peripartum period: a systematic review of current knowledge and clinical implications
In brief
Up to 40% of axial spondyloarthritis pregnancies flare after biologic withdrawal
A systematic review of 167 studies found disease activity stable in psoriatic arthritis pregnancies but variable in axial SpA, with flares in up to 40% of pregnancies, especially when TNF-inhibitors were stopped. Pregnancy outcomes were generally favorable, though preterm birth, cesarean delivery and small-for-gestational-age infants were modestly increased. Continuing biologics and limiting NSAID use may improve outcomes, but high-quality prospective data are still needed.
- Journal
- Therapeutic advances in musculoskeletal disease (Q1)
- Published
- 11 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Noémie Gross, Anna Molto, Renaud Felten
- PMID
- 42732179
- DOI
- 10.1177/1759720X261444224
Why clinicians should know about it
- Picked for Rheumatology (paper of the day, 14 September 2026): Systematic review of SpA in peripartum period, clinical implications
Abstract
BACKGROUND: Spondyloarthritis (SpA) commonly affects women of reproductive age, yet evidence on fertility, pregnancy outcomes and postpartum disease activity remains fragmented. The growing recognition of non-radiographic axial SpA (axSpA) and the wider use of biologics have increased the need for reproductive-health data in this population. OBJECTIVES: To systematically review the evidence on fertility, pregnancy course, therapeutic management, obstetric and neonatal outcomes and postpartum disease activity in women with SpA. DESIGN: Systematic literature review. METHODS: We performed a systematic search of PubMed/MEDLINE using predefined MeSH-based equations addressing fertility, pregnancy and the postpartum period in SpA. English and French studies were included without date restriction. Data extraction followed a PICO/PECO framework and findings were synthesized thematically according to PRISMA guidance. RESULTS: Of 337 publications identified, 167 met the inclusion criteria. Evidence indicates a modest reduction in ovarian reserve and longer time-to-pregnancy in some women with SpA, partly influenced by non-steroidal anti-inflammatory drugs (NSAIDs) exposure. Disease activity during pregnancy is generally stable in PsA but more variable in axSpA; flares occur in up to 40% of pregnancies, especially after biologic discontinuation. Overall pregnancy outcomes are favourable, though risks of preterm birth, caesarean delivery and small-for-gestational-age infants are modestly increased. Biologic therapies, especially tumour necrosis factor inhibitors, appear safe and contribute to disease control. Postpartum flares are common, particularly in axSpA, and breastfeeding is generally compatible with most treatments. CONCLUSION: When disease activity is well controlled and treatment is optimized, reproductive outcomes in women with SpA are largely favourable. Avoiding unnecessary NSAID exposure, maintaining appropriate biologic therapy when indicated and close peripartum monitoring are key to improving outcomes. High-quality prospective studies remain needed to refine clinical guidance.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.