March 22, 2023

Dr. Kathryn Dao discusses abstracts POS1405, POS0696 and OP0130 presented at the EULAR 2022 meeting.

Hi this is dr catherine dowd reporting from dallas i am day two of ular and i am reporting for room now so i wanted to share with you a few posters about d mars biologics protozoan and pregnancy i think this is such an important topic and if you’re as interested as i am then you can call yourself a reproductive rheumatologist so let’s talk about the first poster

This is poster fourteen zero five and this poster is titled less than fifty percent of females with chronic rheumatic inflammatory diseases actually continue a demar during pregnancy so this is a retrospective cohort study of women who had chronic inflammatory rheumatic diseases and it’s actually derived from the french healthcare database so this covers about 98

Of the french population and there were over 11 000 patients and they had a singleton pregnancy during the 10-year study period which is a lot of babies so the data showed that during pregnancy 42 of these women were not on any kind of dmard or steroids and then 32 of them were actually on conventional synthetic dmards and 25 on a biologic what’s interesting was

That 30 of them had exposure to a non-steroidal anti-inflammatory drug and nsaid during the first trimester now that number did drop in the second and third trimester to six and two percent and exposure to cortical steroids was pretty common occurring in about a third of all pregnancies even through the third trimester now this is really alarming because um

We like to minimize steroids obviously because of all the risks that it can pose during pregnancy like gestational diabetes um there’s been some suggestion of possibility of cleft palate palate malformation so it’s also unclear whether or not these patients were on steroids because they declined to be on a dmard if their disease was already doing well or if the

Treating physician are not aware of pregnancy compatible demards needless to say half of the prescriptions failed for steroids were more than 10 milligrams so that’s actually a pretty significant amount of steroids so following that up is poster zero six nine six does prednisone use during pregnancy induce insulin resistance in offsprings so that is a big question

Because we prescribe steroids sometimes these women have to have five milligrams a day of steroids but what happens to the baby and to the baby not just as a baby but the baby as a child so this study sought to answer that question they wanted to know whether or not in utero exposure to steroids can actually impact insulin resistance into early childhood so this

Is a netherlands study looking at about 103 children now their mothers had participated in a prospective rheumatoid arthritis pregnancy study 42 of these children had an unusual exposure to prednisone 61 were not exposed and so the children after they were born were assessed for insulin resistance and this was measured through the homeostasis model of assessment

Insulin resistance or homa ir they also measured serum adiponectin lipid levels and they also corrected for body fat distribution so the good news here is that the authors really didn’t find any difference um between the homa ir adiponectin level body fat distribution of lipids between exposed groups or non-exposed groups through seven years of age so if you do

Have to have a patient who needs to have steroids during the entire pregnancy at least it’s reassuring that it’s not affecting the baby as much but even so if there is an alternative to steroids i really think that you should try to have the patient switch to a demard and then the last study i want to emphasize is oral presentation 0 1 3 0. now this is a very

Interesting study because you know we always said that certain ismab is really safe in pregnancy because it doesn’t cross the placenta well the study wants to see well should you really switch tnf inhibitors during pregnancy and so they went ahead and looked and actually it’s a pretty large number dr leah flatman presented this data 26 000 offsprings right and

They she what she did was she studied um a comparison between high placental transfer tnf inhibitors versus lotus placental transfer nurse and she found really at the end no difference in serious infectious events in childhood now obviously um what was not looked at is like vaccination right after birth because there are some some countries that still give the baby

Bcg um right at birth so we’re not quite sure whether or not that might impact the baby’s ability to not have disseminated bacillus so that’s my take on pregnancy i hope you’re having a great day this is dr cat catherine dao reporting for room now follow me on twitter at kdow2011 you

Transcribed from video
DMARDS, Prednisone, Pregnancy, OH MY! By RheumNow