Pregnant women with inflammatory arthritis may be at increased risk for adverse pregnancy outcomes. Despite prior research into the effects of disease activity and medication use, it’s unclear what drives the risk. New research by Chelsey J.F. Smith, MD, University of California San Diego, La Jolla, and Cedars-Sinai Medical Center, Los Angeles, and colleagues assessed the risk of pregnancy complications, such as preterm delivery, in women with rheumatoid arthritis (RA) and women with juvenile idiopathic arthritis (JIA) in comparison with a healthy cohort.
Researchers used patient data from the Organization of Teratology Information Specialists (OTIS) Autoimmune Disease in Pregnancy Project. Data on pregnancy events, medication, disease activity and pregnancy outcomes were obtained by maternal report and validated by medical records. Patients enrolled in the OTIS Autoimmune Disease in Pregnancy Project between 2004 and 2017. In total, 657 women with RA, 170 women with JIA and 564 women without autoimmune disease were included in the analysis. The results of this prospective cohort study were published in the August 2019 issue of Arthritis Care & Research.
The Results
“Our study demonstrates that women with RA and women with JIA are at an increased risk for preterm delivery and early term delivery,” write the authors.
In the analyses, mothers with RA and JIA had a higher risk of preterm labor, early-term delivery, moderate preterm delivery and caesarian section than those in the comparison group. Women with RA had a significantly higher risk of preterm delivery before 32 weeks of gestation and gestational diabetes mellitus than the comparison group. Women with JIA had a higher risk of preeclampsia than the comparison group.
Active disease, which was defined as a Patient Activity Scale score greater than 3.7, was associated with preterm delivery in women with RA both at baseline and any time during pregnancy. This association remained after adjusting for age, race, body mass index and other variables. Disease activity was not significantly associated with preterm delivery among women with JIA.
Corticosteroid use during any trimester of pregnancy was significantly associated with preterm delivery among women with RA and JIA. The use of NSAIDs in the first trimester was associated with preterm delivery in women with JIA. The use of disease-modifying anti-rheumatic drugs and biologic treatments were not associated with increased risk for preterm delivery. The authors note the difficulty in distinguishing between the effects of disease activity and corticosteroid use on preterm delivery, calling for more research.
“Further analyses are necessary to look at other categories of arthritis affecting women of childbearing age, racial disparities in these populations, as well as the influence of disease activity in the later stages of pregnancy on other perinatal factors that may contribute to preterm delivery risk,” conclude the authors.
Smith CJF, Forger F, Bandoli G, et al. Factors associated with preterm delivery among women with rheumatoid arthritis and women with juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2019 Aug;71(8):1019–1027.
