Biologic Therapy at Conception in Inflammatory Rheumatic Diseases: Real-World Experience and Pregnancy Outcomes

Objective: To describe real-world biologic treatment patterns, maternal disease activity, and pregnancy outcomes in women with inflammatory rheumatic diseases, and to explore biologic treatment selection patterns according to preconception planning status.Methods: This retrospective observational single-center study included women with inflammatory rheumatic diseases who conceived while receiving biologic disease-modifying antirheumatic drugs (bDMARDs) between 2015 and 2021. Data on clinical characteristics, treatment patterns, preconception planning, disease activity, and maternal-neonatal outcomes were extracted from medical records and analyzed using descriptive statistics.Results: Fifteen pregnancies were included. The mean maternal age at conception was 33.1 ± 4.0 years, and the median duration of bDMARD exposure before conception was 37 months (interquartile range [IQR]: 13-64). Spondyloarthritis and psoriatic arthritis were the most common diagnoses (n = 6, 40% each). Most pregnancies were planned (n = 12, 80%), and 10 patients (66.7%) received preconception counseling. At conception, 13 patients (86.7%) were in remission or partial remission. Certolizumab pegol was continued throughout pregnancy in 10 patients (66.7%), whereas adalimumab was discontinued during the first trimester in all 4 patients. Biologic therapy was restarted during pregnancy in 3 patients. Maternal and neonatal outcomes were generally favorable, with 1 case of premature rupture of membranes and 1 preterm birth at 35 weeks. No major congenital anomalies were observed.Conclusion: Although certolizumab pegol was the most frequently used biologic agent, biologic therapy was commonly discontinued during pregnancy, with reinitiation required in some patients. These findings support structured preconception planning and individualized biologic treatment decisions to maintain maternal disease control during pregnancy.