PREGNANCY COURSE AND OUTCOMES IN WOMEN WITH FAMILIAL MEDITERRANEAN FEVER

Aim. To study pregnancy course and outcomes in patients with familial Mediterranean fever (FMF). Materials and methods. An observational cohort study compared pregnancy outcomes in 251 women with FMF and in 312 women without FMF. A group of women (4577) of reproductive age (18-49 years) with confirmed diagnosis of FMF was sequentially selected among 32,000persons of Armenian nationality, who were examined for the presence of mutations in MEFV gene and their clinical, laboratory and genetic test results were included in the information register for the period 1998-2018 in the Center for Medical Genetics and Primary Health Care, Yerevan, Armenia. The main group included 211 patients with FMF. Inclusion criteria were: termination of pregnancy or abortion, obstetric complications, perinatal outcomes. The results were processed using the SPSS Statistics 16.0 software package. To study a possible relationship between a certain outcome and risk factor in the compared groups, the data were processed using the GraphPad Prism 4 and GraphPad Prism 5 software packages. Relative risk (RR) with 95% confidence interval (CI) was calculated. Results. Pregnancy complications associated with FMF were found as follows: preterm delivery (PTD<37 weeks) (RR=1.9; 95% CI 1.2-4.4, р=0.036); ectopic pregnancy (eP) (RR=1.5; 95% CI 1.1-2.7, р=0.018). In patients with FMF 149pregnancies (59.3%) without complications resulted in 184 live births (73.3%) (RR=1.0; 95% CI 0.9-1.0, р=0.811). In patients without FMF 190pregnancies (61.0%) resulted in 231 live births (74.0%). There were no significant differences among the groups with early (15.9% vs. 16.3%, p=0.326) and late miscarriages (1.6% vs. 3.2%, p=0.457), сesarean delivery (CD) (12.6% vs. 13.2%, p=0.794), premature detachment of a normally positioned placenta (PDNPP)(0.4% vs. 1.0%, p=0.431), intrauterine growth restriction (IUGR) (1.2% vs. 1.3%, p=0.930), preeclampsia (PE) (3.2% vs. 3.2%, p=0.996), intrauterine fetal hypoxia (2.4% vs.1.9%, p=0.699), antenatal fetal death (AFD) (2.4% vs. 3.5%, p=0.438), fertility treatment (24.7% vs. 23.7%, p=0.823), respectively. Perinatal outcomes in the groups were comparable: low Apgar scores at the 1st minute (<7) (1.6% vs. 2.5%, p=0.497) and and the 5th minute (0.5% vs. 0.4%, p=0.875), congenital malformations (CM) (1.6% vs. 2.6%, p=0.431) and perinatal mortality (PM) (3.2% vs. 4.5%, p=0.438), respectively. In 75.3% of patients with FMF, the average maternal age at delivery was 19-35 years, compared to 47.1% in the control group. Women without FMF were older (>36 years - 51.2%, p<0.0001). The average birth weight in babies (2500-4000 g) was lower in the main group (64.2% vs. 80.2%, p<0.0001). Assessment of pregnancy outcomes in 131 (52.2%)patients who were taking colchicine, and 120 (47,8%) who were not taking colchicine or not taking regularly did not show differences regarding CM, PE, PDNPP, IUGR, AFD, PM, late miscarriage, CD. Controlling FMF attacks in 88,5% of cases and more favourable pregnancy outcomes were due to intake of colchicine: early miscarriages (13.7% vs. 18.3%, p=0.326; respectively), PTD (5,3% vs. 8.3%;p=0.121),<37 weeks (5.3% vs. 8.3%, p=0.121; respectively), EP(4.6% vs. 9.2%, p=0.225), respectively, but the results did not reach statistical significance. Conclusion. Familial Mediterranean fever is associated with an increased risk of preterm delivery, lower birth weight and ectopic pregnancy. Perinatal outcomes in patients with and without FMF are comparable. Colchicine treatment of pregnant women with FMF has a beneficial effect on the clinical course of the disease and does not affect pregnancy outcomes.

familial Mediterranean fever, preterm delivery, cesarean delivery, colchicine, pregnancy outcome