Skip to main content

Advertisement

SpringerLink
Log in

Pregnancy outcomes in women with ankylosing spondylitis: a scoping literature and methodological review

  • Review Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

In this scoping review, we sought to summarize the types of outcomes collected in pregnant patients with ankylosing spondylitis (AS), and to identify some methodological limitations related to pregnancy research in these patients. A comprehensive search was done to identify relevant articles in MEDLINE and Embase. We included 21 studies assessing pregnancy outcomes in AS. Most studies reported disease flare during pregnancy, and few reported improved disease activity or stable disease. Disease flare occurred in 25–80% of patients during pregnancy and in 30–100% during the postpartum. There was no increased risk of pre-eclampsia across all studies. Based on two case-control studies, there was an increased risk for prematurity and small for gestational age in AS pregnancies, pooled odds ratio (95% confidence interval) 1.99 (1.30–3.05) and 2.41 (1.22–4.77), respectively. The etiologies of cesarean section were not related to joint issues from AS but were related to other causes like pre-eclampsia and prematurity. Some key methodological issues were related to the study design, selection of study participants, disease classification, choice of control participants, and outcome measures. Based on the current literature review, some key areas for future research should evaluate the disease state at conception, effects of pharmacological treatment for AS during pregnancy, and long-term outcomes of children born to women with AS. The use of pregnancy registers and validated measurement tools in pregnancy will help to improve the state and quality of evidence in this field.

Key Points

• Disease flare during pregnancy in patients with ankylosing spondylitis (AS) occurred in 25–80% of the cases in the various studies, and in 30–100% of the cases during the postpartum period.

• There was an increased risk for prematurity, and no increased risk of pre-eclampsia or small for gestational age. Etiologies of cesarean section were not related to the hip or sacroiliac joint affection of the disease but to other causes like pre-eclampsia and prematurity.

• This study provides a comprehensive overview of issues related to research on pregnant women with ankylosing spondylitis (AS). We addressed methodological issues related to the study design, selection of study participants, disease classification, control choice, assessment of outcomes measures, and statistical analysis.

• The use of pregnancy registers and validated disease activity measurement tools for pregnancy can enhance pregnancy research in women with AS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Zochling J, Smith EU (2010) Seronegative spondyloarthritis. Best practice and research. Clin Rheumatol 24(6):747–756. https://doi.org/10.1016/j.berh.2011.02.002

    Article  Google Scholar 

  2. Park EH, Jun JK, Lee SM, Song YW, Lee EB (2017) Pregnancy outcomes in Korean women with ankylosing spondylitis. Ann Rheum Dis 76(Supplement 2):922–923. https://doi.org/10.1136/annrheumdis-2017-eular.2511

    Article  Google Scholar 

  3. Sammaritano LR (2013) Pregnancy in rheumatic disease patients. J Clin Rheumatol 19(5):259–266. https://doi.org/10.1097/RHU.0b013e31829ce35f

    Article  PubMed  Google Scholar 

  4. Keeling SO, Oswald AE (2009) Pregnancy and rheumatic disease: “by the book” or “by the doc”. Clin Rheumatol 28(1):1–9. https://doi.org/10.1007/s10067-008-1031-9

    Article  PubMed  Google Scholar 

  5. Lui NL, Haroon N, Carty A, Shen H, Cook RJ, Shanmugarajah S, Gladman DD, Inman RD (2011) Effect of pregnancy on ankylosing spondylitis: a case-control study. J Rheumatol 38(11):2442–2444. https://doi.org/10.3899/jrheum.101174

    Article  PubMed  Google Scholar 

  6. Ostensen M, Husby G (1984) Pregnancy and rheumatic disease. A review of recent studies in rheumatoid arthritis and ankylosing spondylitis. Klin Wochenschr 62(19):891–895

    Article  CAS  PubMed  Google Scholar 

  7. Ostensen M, Husby G (1983) A prospective clinical study of the effect of pregnancy on rheumatoid arthritis and ankylosing spondylitis. Arthritis Rheum 26(9):1155–1159. https://doi.org/10.1002/art.1780260915

    Article  CAS  PubMed  Google Scholar 

  8. Zhou Q, Bian XM, Liu JT (2012) Management of pregnancy with ankylosing spondylitis. Chin Med Sci J 27(1):46–49

    Article  CAS  PubMed  Google Scholar 

  9. Förger F, Østensen M, Schumacher A, Villiger PM (2005) Impact of pregnancy on health related quality of life evaluated prospectively in pregnant women with rheumatic diseases by the SF-36 health survey. Ann Rheum Dis 64(10):1494–1499. https://doi.org/10.1136/ard.2004.033019

    Article  PubMed  PubMed Central  Google Scholar 

  10. Förger F, Villiger PM, Ostensen M (2009) Pregnancy in patients with ankylosing spondylitis: do regulatory T cells play a role? Arthritis Rheum 61(2):279–283. https://doi.org/10.1002/art.24161

    Article  PubMed  Google Scholar 

  11. Ostensen M, Romberg O, Husby G (1982) Ankylosing spondylitis and motherhood. Arthritis Rheum 25(2):140–143

    Article  CAS  PubMed  Google Scholar 

  12. Timur H, Tokmak A, Türkmen GG, Ali İnal H, Uygur D, Danışman N (2016) Pregnancy outcome in patients with ankylosing spondylitis. J Matern Fetal Neonatal Med 29(15):2470–2474. https://doi.org/10.3109/14767058.2015.1089432

    Article  CAS  PubMed  Google Scholar 

  13. Ursin K, Lydersen S, Skomsvoll JF, Wallenius M (2018) Disease activity during and after pregnancy in women with axial spondyloarthritis: a prospective multicentre study. Rheumatology 57(6):1064–1071. https://doi.org/10.1093/rheumatology/key047

    Article  PubMed  Google Scholar 

  14. Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE (2018) Gender differences in axial spondyloarthritis: women are not so lucky. Curr Rheumatol Rep 20(6):35. https://doi.org/10.1007/s11926-018-0744-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Robinson PC, Sengupta R, Siebert S (2019) Non-radiographic axial spondyloarthritis (nr-axSpA): advances in classification, imaging and therapy. Rheumatol Ther 6(2):165–177. https://doi.org/10.1007/s40744-019-0146-6

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lindström U, Olofsson T, Wedrén S, Qirjazo I, Askling J (2019) Biological treatment of ankylosing spondylitis: a nationwide study of treatment trajectories on a patient level in clinical practice. Arthritis Res Ther 21(1):128. https://doi.org/10.1186/s13075-019-1908-9

    Article  PubMed  PubMed Central  Google Scholar 

  17. Munn Z, Porritt K, Lockwood C, Aromataris E, Pearson A (2014) Establishing confidence in the output of qualitative research synthesis: the ConQual approach. BMC Med Res Methodol 14:108–108. https://doi.org/10.1186/1471-2288-14-108

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pearson A, Jordan Z, Munn Z (2012) Translational science and evidence-based healthcare: a clarification and reconceptualization of how knowledge is generated and used in healthcare. Nurs Res Pract 2012:792519–792516. https://doi.org/10.1155/2012/792519

    Article  PubMed  PubMed Central  Google Scholar 

  19. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E (2018) Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol 18(1):143. https://doi.org/10.1186/s12874-018-0611-x

    Article  PubMed  PubMed Central  Google Scholar 

  20. Arksey H, O’Malley L (2005) Scoping studies: towards a methodological framework. Int J Soc Res Methodol 8(1):19–32. https://doi.org/10.1080/1364557032000119616

    Article  Google Scholar 

  21. Jakobsson GL, Stephansson O, Askling J, Jacobsson LT (2016) Pregnancy outcomes in patients with ankylosing spondylitis: a nationwide register study. Ann Rheum Dis 75(10):1838–1842. https://doi.org/10.1136/annrheumdis-2015-207992

    Article  PubMed  Google Scholar 

  22. Mørk S, Voss A, Möller S, Bliddal M (2019) Spondyloarthritis and outcomes in pregnancy and labor: a nationwide register‐based cohort study. Arthritis Care Res:23. https://doi.org/10.1002/acr.24111

  23. Park EH, Lee JS, Kim YJ, Lee SM, Jun JK, Lee EB, Kim YG (2019) Pregnancy outcomes in Korean women with ankylosing spondylitis. Korean J Intern Med 26. https://doi.org/10.3904/kjim.2019.144

  24. Ostensen M, von Schoultz B, Husby G (1983) Comparison between serum alpha 2-pregnancy-associated globulin and activity of rheumatoid arthritis and ankylosing spondylitis during pregnancy. Scand J Rheumatol 12(3):315–318

    Article  CAS  PubMed  Google Scholar 

  25. Ostensen M (1984) The influence of pregnancy on blood parameters in patients with rheumatic disease. Scand J Rheumatol 13(3):203–208

    Article  CAS  PubMed  Google Scholar 

  26. Ostensen M, Ostensen H (1998) Ankylosing spondylitis--the female aspect. J Rheumatol 25(1):120–124

    CAS  PubMed  Google Scholar 

  27. Østensen M, Fuhrer L, Mathieu R, Seitz M, Villiger PM (2004) A prospective study of pregnant patients with rheumatoid arthritis and ankylosing spondylitis using validated clinical instruments. Ann Rheum Dis 63(10):1212–1217. https://doi.org/10.1136/ard.2003.016881

    Article  PubMed  PubMed Central  Google Scholar 

  28. Østensen M, Förger F, Nelson JL, Schuhmacher A, Hebisch G, Villiger PM (2005) Pregnancy in patients with rheumatic disease: anti-inflammatory cytokines increase in pregnancy and decrease post partum. Ann Rheum Dis 64(6):839–844

    Article  PubMed  Google Scholar 

  29. Davutoğlu EA, Ozel A, Yılmaz N, Madazli R (2017) Pregnancy outcome in 162 women with rheumatic diseases: experience of a university hospital in Turkey. Arch Gynecol Obstet 296(6):1079–1084. https://doi.org/10.1007/s00404-017-4535-1

    Article  PubMed  Google Scholar 

  30. van den Brandt S, Zbinden A, Baeten D, Villiger PM, Østensen M, Förger F (2017) Risk factors for flare and treatment of disease flares during pregnancy in rheumatoid arthritis and axial spondyloarthritis patients. Arthritis Res Ther 19(1):64. https://doi.org/10.1186/s13075-017-1269-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Zbinden A, van den Brandt S, Østensen M, Villiger PM, Förger F (2018) Risk for adverse pregnancy outcome in axial spondyloarthritis and rheumatoid arthritis: disease activity matters. Rheumatology 57(7):1235–1242. https://doi.org/10.1093/rheumatology/key053

    Article  PubMed  Google Scholar 

  32. Smith CJF, Bandoli G, Kavanaugh A, Chambers CD (2019) Birth outcomes and disease activity during pregnancy in a prospective cohort of women with psoriatic arthritis and ankylosing spondylitis. Arthritis Care Res 10:1029–1037. https://doi.org/10.1002/acr.23924

    Article  CAS  Google Scholar 

  33. Unal C, Fadiloglu E, Tanacan A, Zaim OC, Beksac MS (2020) Retrospective evaluation of pregnancies with ankylosing spondylitis in a tertiary center in Turkey. Int J Rheum Dis 23(1):101–105. https://doi.org/10.1111/1756-185X.13746

    Article  PubMed  Google Scholar 

  34. Higgins JPT TJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (2019) Handbook for Systematic Reviews of Interventions version 6.0 Available from http://www.training.cochrane.org/handbook

  35. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JAC (2011) Cochrane bias methods group, Cochrane statistical methods group. BMJ 343:d5928–d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wells GA, Tugwell P, O’Connell D, Welch V, Peterson J, Shea B, Losos M (2015) The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses

  37. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358:j4008. https://doi.org/10.1136/bmj.j4008

    Article  PubMed  PubMed Central  Google Scholar 

  38. Molto A, Gensler L, Clowse MEB, Marzo-Ortega H, Artignan A, Goff-Leggett D, Leonard S, Resemann HK, Thurtle E, De Peyrecave N, Ecoffet C, Forger F (2018) Pregnancy outcomes and disease activity in women with axial spondyloarthritis: a systematic literature review. Ann Rheum Dis 77(Supplement 2):340–341. https://doi.org/10.1136/annrheumdis-2018-eular.3056

    Article  Google Scholar 

  39. Krishna G, Shajpal A, Divall P, Khare M, Moorthy A (2019) A systematic review of pregnancy outcome in ankylosing spondylitis. Ann Rheum Dis 78(Supplement 2):479. https://doi.org/10.1136/annrheumdis-2019-eular.5002

    Article  Google Scholar 

  40. Giovannopoulou E, Gkasdaris G, Kapetanakis S, Kontomanolis E (2017) Ankylosing spondylitis and pregnancy: a literature review. Curr Rheumatol Rev 13(3):162–169. https://doi.org/10.2174/1573397113666170317114857

    Article  PubMed  Google Scholar 

  41. Gandaloeva Z, Krichevskaya O, Dubinina T (2019) Drug therapy of ankylosing spondylitis (as) during pregnancy in real clinical practice. Ann Rheum Dis 78(Supplement 2):880. https://doi.org/10.1136/annrheumdis-2019-eular.6750

    Article  Google Scholar 

  42. Crisafulli F, Andreoli L, Gerardi MC, Fernandez AG, Nalli C, Filippini M, Gorla R, Taglietti M, Fredi M, Lazzaroni MG, Lojacono A, Zatti S, Franceschini F, Tincani A (2019) Disease course and outcomes during pregnancy in patients with axial spondiloarthritis: comparison between TNFi users and naive patients. Ann Rheum Dis 78(Supplement 2):878. https://doi.org/10.1136/annrheumdis-2019-eular.7705

    Article  Google Scholar 

  43. Levy RA, Vilela VS, Cataldo MJ, Ramos RC, Duarte JL, Tura BR, Albuquerque EM, Jesús NR (2001) Hydroxychloroquine (HCQ) in lupus pregnancy: double-blind and placebo-controlled study. Lupus 10(6):401–404. https://doi.org/10.1191/096120301678646137

    Article  CAS  PubMed  Google Scholar 

  44. Pattison NS, Chamley LW, Birdsall M, Zanderigo AM, Liddell HS, McDougall J (2000) Does aspirin have a role in improving pregnancy outcome for women with the antiphospholipid syndrome? A randomized controlled trial. Am J Obstet Gynecol 183(4):1008–1012. https://doi.org/10.1067/mob.2000.106754

    Article  CAS  PubMed  Google Scholar 

  45. Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, Marder W, Guyatt G, Branch DW, Buyon J, Christopher-Stine L, Crow-Hercher R, Cush J, Druzin M, Kavanaugh A, Laskin CA, Plante L, Salmon J, Simard J, Somers EC, Steen V, Tedeschi SK, Vinet E, White CW, Yazdany J, Barbhaiya M, Bettendorf B, Eudy A, Jayatilleke A, Shah AA, Sullivan N, Tarter LL, Birru Talabi M, Turgunbaev M, Turner A, D’Anci KE (2020) American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol 72:529–556. https://doi.org/10.1002/art.41191

    Article  PubMed  Google Scholar 

  46. Song JW, Chung KC (2010) Observational studies: cohort and case-control studies. Plast Reconstr Surg 126(6):2234–2242. https://doi.org/10.1097/PRS.0b013e3181f44abc

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Burns PB, Rohrich RJ, Chung KC (2011) The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 128(1):305–310. https://doi.org/10.1097/PRS.0b013e318219c171

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Mann CJ (2003) Observational research methods. Research design II: cohort, cross sectional, and case-control studies. Emerg Med J 20(1):54–60. https://doi.org/10.1136/emj.20.1.54

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Mazzali C, Paganoni AM, Ieva F, Masella C, Maistrello M, Agostoni O, Scalvini S, Frigerio M, Data Project HF, on behalf of the HFDP (2016) Methodological issues on the use of administrative data in healthcare research: the case of heart failure hospitalizations in Lombardy region, 2000-2012. BMC Health Serv Res 16(1):234. https://doi.org/10.1186/s12913-016-1489-0

    Article  PubMed  PubMed Central  Google Scholar 

  50. Gavrielov-Yusim N, Friger M (2014) Use of administrative medical databases in population-based research. J Epidemiol Community Health 68(3):283–287. https://doi.org/10.1136/jech-2013-202744

    Article  PubMed  Google Scholar 

  51. Vinet E, Chakravarty EF, Simard JF, Clowse M (2018) Use of administrative databases to assess reproductive health issues in rheumatic diseases. Rheum Dis Clin N Am 44(2):327–336. https://doi.org/10.1016/j.rdc.2018.01.008

    Article  Google Scholar 

  52. Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, Braun J, Chou CT, Collantes-Estevez E, Dougados M, Huang F, Gu J, Khan MA, Kirazli Y, Maksymowych WP, Mielants H, Sørensen IJ, Ozgocmen S, Roussou E, Valle-Oñate R, Weber U, Wei J, Sieper J (2009) The development of Assessment of Spondyloarthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68(6):777–783. https://doi.org/10.1136/ard.2009.108233

    Article  CAS  PubMed  Google Scholar 

  53. Malay S, Chung KC (2012) The choice of controls for providing validity and evidence in clinical research. Plast Reconstr Surg 130(4):959–965. https://doi.org/10.1097/PRS.0b013e318262f4c8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A (2016) Physiological changes in pregnancy. Cardiovasc J Afr 27(2):89–94. https://doi.org/10.5830/CVJA-2016-021

    Article  PubMed  PubMed Central  Google Scholar 

  55. MacLean MA, Wilson R, Thomson JA, Krishnamurthy S, Walker JJ (1992) Immunological changes in normal pregnancy. Eur J Obstet Gynecol Reprod Biol 43(3):167–172. https://doi.org/10.1016/0028-2243(92)90169-y

    Article  CAS  PubMed  Google Scholar 

  56. Chen D, Lao M, Zhang J, Zhan Y, Li W, Cai X, Zhan Z (2018) Fetal and maternal outcomes of planned pregnancy in patients with systemic lupus erythematosus: a retrospective multicenter study. J Immunol Res 2018:2413637–2413637. https://doi.org/10.1155/2018/2413637

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Warren RB, Reich K, Langley RG, Strober B, Gladman D, Deodhar A, Bachhuber T, Bao W, Altemeyer E, Hussain S, Safi J (2018) Secukinumab in pregnancy: outcomes in psoriasis, psoriatic arthritis and ankylosing spondylitis from the global safety database. Br J Dermatol 179(5):1205–1207. https://doi.org/10.1111/bjd.16901

    Article  CAS  PubMed  Google Scholar 

  58. Clowse MEB, Scheuerle AE, Chambers C, Afzali A, Kimball AB, Cush JJ, Cooney M, Shaughnessy L, Vanderkelen M, Förger F (2018) Pregnancy outcomes after exposure to certolizumab pegol: updated results from a pharmacovigilance safety database. Arthritis Rheumatol 70(9):1399–1407. https://doi.org/10.1002/art.40508

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Meissner Y, Fischer-Betz R, Andreoli L, Costedoat-Chalumeau N, De Cock D, Dolhain R, Forger F, Goll D, Molto A, Ozdemir R, Raio L, Nelson-Piercy C, Rodriguez-Garcia SC, Sciascia S, Wallenius M, Zbinden A, Zink A, Strangfeld A (2019) Development of a standardized minimal core data set for pregnancy registers in rheumatology - results of a EULAR task force. Ann Rheum Dis 78(Supplement 2):246. https://doi.org/10.1136/annrheumdis-2019-eular.4021

    Article  Google Scholar 

  60. Meissner Y, Strangfeld A, Costedoat-Chalumeau N, Forger F, Molto A, Wallenius M, Fischer-Betz R (2018) Defining a standardized core data set for pregnancy registers in rheumatic diseases-an European approach. Arthritis Rheumatol 70(Supplement 9):2684–2685. https://doi.org/10.1002/art.40700

    Article  Google Scholar 

  61. Eudy AM, Petri M, Fischer-Betz R, Mokbel A, Nalli C, Andreoli L, Tincani A, Molad Y, Gladman D, Urowitz M, Balevic S, Clowse ME (2018) CS−03 hydroxychloroquine in lupus pregnancy: a meta-analysis of individual participant data. Lupus Sci Med 5(Supplement 2):A21. https://doi.org/10.1136/lupus-2018-lsm.38

    Article  Google Scholar 

  62. Andreoli L, Gerardi MC, Fernandes M, Bortoluzzi A, Bellando-Randone S, Brucato A, Caporali R, Chighizola CB, Chimenti MS, Conigliaro P, Cutolo M, Cutro MS, D’Angelo S, Doria A, Elefante E, Fredi M, Galeazzi M, Gerosa M, Govoni M, Iuliano A, Larosa M, Lazzaroni MG, Matucci-Cerinic M, Meroni M, Meroni PL, Mosca M, Patanè M, Pazzola G, Pendolino M, Perricone R, Ramoni V, Salvarani C, Sebastiani GD, Selmi C, Spinelli FR, Valesini G, Scirè CA, Tincani A (2019) Disease activity assessment of rheumatic diseases during pregnancy: a comprehensive review of indices used in clinical studies. Autoimmun Rev 18(2):164–176. https://doi.org/10.1016/j.autrev.2018.08.008

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Malak Maaraba (medical student) and Dr. Sherif Gamal for their work as second reviewers and in extracting the data. We are indebted to Dr. Megan Clowse for discussing the main concepts of the review and for her valuable remarks.

Author information

Authors and Affiliations

  1. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Abir Mokbel, Daeria O. Lawson & Forough Farrokhyar

  2. Department of Rheumatology, Cairo University, Giza, Egypt

    Abir Mokbel

  3. Division of Rheumatology, Toronto Western Hospital, Toronto, ON, Canada

    Daeria O. Lawson

  4. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Forough Farrokhyar

Authors
  1. Abir Mokbel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daeria O. Lawson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Forough Farrokhyar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Abir Mokbel: study conception, protocol writing, search, screening and data extraction, analysis, writing of the manuscript. Daeria O. Lawson: critical revision of the methodology, writing of the manuscript. Forough Farrokhyar: protocol revision. All the authors were involved in the critical revision of the manuscript and approved the final version.

Corresponding author

Correspondence to Abir Mokbel.

Ethics declarations

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 32 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mokbel, A., Lawson, D.O. & Farrokhyar, F. Pregnancy outcomes in women with ankylosing spondylitis: a scoping literature and methodological review. Clin Rheumatol 40, 3465–3480 (2021). https://doi.org/10.1007/s10067-021-05588-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-021-05588-9

Keywords

Search

Navigation