Women With axSpA and PsA Have Higher Risk for Cesarean Section 

Compared with the general population, women with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) have an increased risk for elective and emergency cesarean sections (C-sections), respectively, according to study results published in RMD Open.

Researchers conducted a population-based cohort study to evaluate the incidence of C-sections among women aged older than 16 years with a rheumatic disease diagnosis who were planning a pregnancy. 

Data were collected from the Medical Birth Registry of Norway (MBRN), a nationwide Norwegian register that tracks rheumatic disease activity in pregnant women. Maternal variables, such as age, body mass index (BMI), disease activity, and health related quality of life, were collected from the registry.

Inclusion criteria included a diagnosis of axSpA and PsA.

In total, 575,798 singleton births were evaluated, of which 312 were in the axSpA group and 121 births in the PsA group. The frequency of C-sections were higher in the axSpA and the PsA group compared with the control group (22.4% and 30.6% vs 15.6%, respectively).

Active disease was an indicator of increased C-section frequency in both axSpA and PsA groups (23.7% and 33.3%, respectively). The risk difference of C-section was found to be 6.8% in the axSpA group and 15.0% in the PsA group compared with the control group. In addition, no statistically significant risk difference was found among women with axSpA with inactive disease (2.7%); however, the risk difference was highest among those with active disease (8.1%).

Incidence of emergency C-sections occurred most frequently in women with active PsA (25.9%), with a risk difference of 15.9% compared with the control participants. 

Study limitations included the lack of disease activity measures for pregnancy in women with axSpA and PsA, as well as the exclusion of women with quiescent disease, which may have skewed the population toward those with more severe disease. 

The study authors concluded, “Active disease in the third trimester increased the risk for elective and emergency [C-sections] in prospectively followed women with axSpA and PsA. This finding supports the recommendations of counselling and careful planning before conception and systematic monitoring during pregnancy, targeting inactive disease.”