Maternal and fetal risks in familial mediterranean fever: focus on adverse pregnancy outcomes

To investigate fetal and maternal pregnancy outcomes in pregnant women with familial Mediterranean fever (FMF).

A total of 89 FMF patients with a history of at least one pregnancy were included in this retrospective study. FMF characteristics, obstetric history, FMF attacks during pregnancy, treatments, fetal and maternal complications and adverse pregnancy outcomes (APOs) were recorded.

Overall, 47.2% of patients had FMF attacks during pregnancy (22.5%, 19.1% and 15.7% at the first, second and third trimesters, respectively). APOs were identified in 28.1% (n = 25) of pregnancies, while 29.2% of newborns were admitted to the neonatal intensive care unit (NICU). Majority (95.5%) of patients received FMF treatment during pregnancy including colchicine in 74.2% of patients. Presence of FMF attacks at the second (OR: 15.5, 95% CI: 1.43-167.0, p = 0.024) and third (OR: 20.6, 95% CI: 1.53-278.0, p = 0.023) trimesters was significantly associated with the development of APOs. Presence of FMF attacks during pregnancy (OR 4.63, 95% CI 1.54-13.96, p = 0.006) and higher number of caesarean sections (OR 1.90, 95% CI 1.10-3.29, p = 0.021) were independent predictors of NICU admission.

In conclusion, presence of FMF attacks during pregnancy was associated with the increased risk of APOs and NICU admissions in pregnancies with FMF, alongside their potential association with miscarriage and preterm delivery. Effective control of active disease with close follow-up, prophylaxis and treatment and having a planned pregnancy after achieving disease remission seem to be of critical importance in improving pregnancy outcomes in patients with FMF. Key Points • This study provides data on adverse pregnancy outcomes (APOs) in pregnant women with familial Mediterranean fever (FMF), across demographic, obstetric and clinical characteristics • APOs and need for neonatal intensive care unit (NICU) admission were noted in one third of pregnancies with FMF, emphasizing that fetal complications remain a significant concern in pregnancies with FMF. • FMF attacks occurred in almost half of pregnancies, while having an FMF attack during pregnancy was significantly associated with the increased risk of both APOs and NICU admissions. • Effective control of active disease with close follow-up, prophylaxis and treatment and having a planned pregnancy after achieving disease remission seem to be of critical importance in improving pregnancy outcomes in patients with FMF.