Ankylosing Spondylitis and Pregnancy: A Case Report of a Successful Vaginal Term Delivery

Authors
Nazanin Hesari 1
Mobina Hossein Fakhrabadi 1
Farangis Rajabi 2
1 North Khorasan University of Medical Sciences
2 Mashhad University of Medical Sciences
Abstract
Introduction: Ankylosing spondylitis is a systemic inflammatory disease that causes back and lower limb pain. This disease is rare among women, especially during pregnancy. The present study reports on the pregnancy and delivery of a patient with ankylosing spondylitis.

Case introduction: The patient was a 34-year-old multiparous woman with a history of giving birth to a live baby, who was diagnosed with lumbar disc protrusion nine years ago during the postpartum period due to the sudden onset of symptoms of lower back and hip pain, joint stiffness, and mobility disability. Years later upon performing the HLA-B27 test, it was found that she was suffering from ankylosing spondylitis. At first, she was prescribed sulfasalazine and naproxen, but the patient showed signs of allergy to these drugs, and according to the doctor's prescription, the drugs were changed to adalimumab, methotrexate, and prednisolone. After changing the drugs, the patient's symptoms were controlled. In 2023, with the patient's decision to get pregnant, methotrexate was stopped and adalimumab was stopped after the 23rd week of pregnancy. During pregnancy, the flare-up of spondylitis symptoms caused her hospitalization. Ultimately, the patient, with a gestational age of 40 weeks and one day, passed all stages of labor without any problems and without epidural analgesia, and the result of delivery was a baby with normal perinatal outcomes.

Conclusion: Considering that patients with ankylosing spondylitis are physically and psychologically vulnerable during pregnancy, psychological support and special medical care for them can help improve perinatal outcomes.
Keywords
Ankylosing spondylitis
Pregnancy
vaginal delivery
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