A EULAR 2025 study links high flare rates and complications to the need for tighter inflammation control in pregnancy.
A new French prospective cohort study, presented at the recent EULAR 2025 Congress, provided valuable insight into maternal and neonatal outcomes in autoinflammatory diseases, underscoring the importance of inflammation control and multidisciplinary care.
Autoinflammatory diseases, including familial Mediterranean fever (FMF), often present early in life and disproportionately affect women of childbearing age. While pregnancy is known to destabilise inflammatory conditions and can lead to maternal and foetal complications, prospective data on pregnancy outcomes in this patient population remain limited.
The multi-centre prospective cohort study led by Dr Léa Savey and colleagues tracked 115 pregnancies in 97 women with autoinflammatory diseases from 2016 to 2024.
The majority of participants (81%) were diagnosed with FMF, followed by patients with 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 syndromes.
The researchers found that disease activity persisted through pregnancy. In the year prior to conception, 57.7% of women experienced disease flares, rising slightly to 59.1% during pregnancy.
Among women with FMF, the median age at disease onset was six years, and the mean age at conception was 31 years.
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These patients experienced a mean of four flares annually before pregnancy, with two-thirds (65.7%) reporting inflammatory symptoms during gestation. Notably, three prolonged febrile myalgia syndromes occurred.
Pregnancy complications in the FMF cohort included one case of threatened preterm delivery in a twin pregnancy, one case of anhydramnios, and another of oligohydramnios across two pregnancies in the same patient. Preterm births (<37 weeks) occurred in 17% of cases, exceeding the French national rate of 7%, while 22.4% of singleton infants had a birth weight below the 10th percentile, again substantially higher than the national rate of 7.1%.
Among the women with USAID, the median age of disease onset was 14 years, and they were 30 years at the time of pregnancy.
Half were treated with colchicine, and two patients discontinued biologic therapy upon discovering they were pregnant. Although only one USAID-associated pregnancy resulted in a low-birth-weight infant, the group still showed signs of heightened systemic inflammation: mean C-reactive protein (CRP) at enrolment was 8.9 mg/dL in the USAID group, compared to 22.5 mg/dL in those with FMF.
Presenting the data at the congress, Dr Savey emphasised the clinical importance of inflammation monitoring throughout pregnancy in this population.
“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,” she said.
