SAFETY OF FERTILITY TREATMENTS IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS: DATA FROM A FRENCH PROSPECTIVE POPULATION-BASED STUDY

O063 / #228 Topic: AS21 - Pregnancy and Reproductive Health ABSTRACT CONCURRENT SESSION 11: PREGNANCY IN SLE 24-05-2025 10:40 AM - 11:40 AM Background/Purpose Fertility treatments, which involve the use of exogenous sex hormones, raise concerns about their safety in women with systemic lupus erythematosus (SLE). Methods This study included all pregnancies in women with SLE enrolled in the multicenter French prospective GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares, Clinicaltrial: NCT02450396 ) study, conceived before 1st August 2022, with available end-of-pregnancy data and known conception type.[1] Pregnancies were classified into 2 groups: those conceived naturally and those with assisted conception. Adverse pregnancy outcomes (APOs) were defined as the occurrence of an intrauterine fetal death after 12 weeks of gestation (WG), a placental insufficiency leading to preterm delivery before 37 WG, a small for gestational age, and/or a neonatal death.[1,2] Maternal flares were defined according to the SELENA-SLEDAI Flare Index. The main endpoint was the birth of a living child. Logistic regression was performed to assess whether fertility treatments were independently associated with live birth. Cumulative incidences of disease flares and APOs were also compared using Kaplan-Meier analysis (Cox regression model adjustment). Results 630 pregnancies met eligibility criteria, including 577 pregnancies obtained naturally in 478 women and 53 pregnancies through assisted conception (2 ovulation inductions, 12 intrauterine inseminations, and 39 in vitro fertilizations (IVF)) in 48 women. The mean age of women was older (35.8 vs. 32.3 years, p < 1.10^-4), and twins were more frequent in assisted pregnancies (5/50, 10.0% vs. 20/554, 3.6%; p = 0.047). Lupus disease was clinically inactive at baseline in 51/53 (96.2%) assisted pregnancies (vs 511/570, 89.6%; p = 0.15), with 10 of 45 (22.2%) having chronic damage (vs 65/513, 12.7%; p = 0.07). Lupus anticoagulant (LA) was present in 4/52 (7.7%) assisted pregnancies (vs 72/572, 12.6%; p = 0.38). Hydroxychloroquine was prescribed in 52/53 (98.1%) assisted pregnancies (vs 561/577, 97.2%; p = 1.0). About half of assisted and natural pregnancies (25/48, 52.1% vs 272/522, 52.1%; p = 1.0) were exposed to corticosteroids, but the daily prednisone dosage at inclusion was significantly higher in assisted pregnancies (median dose of 9 [IQR 5.0-10.0] vs. 5 [IQR 5.0-10.0] mg/day; p = 0.025). The live birth rate was similar between assisted and spontaneous pregnancies (46/53, 86.8% vs 505/577, 87.5%; p = 0.83). Assisted conception was not independently associated with achieving a live birth after adjusting for age, number of fetuses, gravidity, disease activity, damage, positive LA, exposure to low-dose aspirin, and daily prednisone dosage at inclusion (adjusted OR = 1.41 (95% CI 0.44-4.47), p = 0.56). At least one flare occurred in 9/53 (17.0%) assisted pregnancies (vs 96/565, 17.0%; p = 0.74). Among pregnancies progressing beyond 12 WG, at least one APO was reported in 8/48 (16.7%) assisted pregnancies (vs 86/525, 16.4%; p = 0.98). Cumulative incidences of flares, and APOs did not differ significantly between both groups. Fertility treatments did not appear to be an independent predictor of the occurrence of flare or APO after adjustment for confounding factors. When the analyses were limited to the group of pregnancies achieved by IVF, results remained unchanged. Conclusions Fertility treatments in women with mostly well-controlled SLE did not appear to increase risks of maternal and neonatal complications, supporting current recommendations.[3] References: [1.] Larosa M. Rheumatology (Oxford) 2022;keab943. [2.] Buyon JP. Ann Intern Med. 2015;163:153-63. [3.] Sammaritano LR. Arthritis Rheumatol 2020;72:529-56.