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Juvenile-onset arthritis may negatively influence pregnancy outcomes

24 Jul 2017

The risk of both maternal and infant complications appears to be high among women with juvenile-onset arthritis (JIA) confined to childhood and among those with JIA persistent into adulthood, a Swedish population-based cohort study has shown.

Researchers looked at 1,807 births among women with JIA and 1,949,202 control births. Given that JIA is a heterogenic condition, births to women with the condition was categorized as JIA paediatric only (n=1,169) and JIA persisting into adulthood (n=638). Generalized estimating equations were used in the analysis.

JIA was found to be associated with an increased risk of preterm birth, especially that which was medically indicated. The adjusted odds ratios [aORs] were 1.74 (95 percent CI, 1.35 to 2.67) in the JIA paediatric subgroup and 4.12 (2.76 to 6.15) in the JIA persisting into adulthood subgroup.

Women with JIA persisting into adulthood were particularly at increased risk of very preterm birth (aOR, 3.14; 1.58 to 6.24), spontaneous preterm birth (aOR, 1.63; 1.11 to 2.39), small for gestational age birth (aOR, 1.84; 1.19 to 2.85), and early-onset and late-onset pre-eclampsia (aOR, 6.28; 2.68 to 13.81 and aOR, 1.96; 1.31 to 2.91, respectively).

On the other hand, women with JIA paediatric only were at higher risk of delivery by caesarean section (aOR, 1.42; 1.66 to 1.73) and induction of labour (aOR, 1.45; 1.18 to 1.77).

No association was found between JIA (regardless of persistence into adulthood) and neonatal death, stillbirth or low Apgar score.

Characterized by onset of arthritis before the age of 16 years, JIA may result in remission or persist into adulthood. In affected women, chronic inflammation such as rheumatoid arthritis and inflammatory bowel disease have been implicated in the excess risk of adverse pregnancy outcomes. Mechanisms by which JIA may affect health in adulthood include ongoing inflammatory activity and exposure to immune-modulatory therapies, systemic effects of past inflammatory activity such as impaired growth during adolescence, and local effects such as joint destruction. [Rheumatology 2013;52:1163–71; Curr Opin Rheumatol 2014;26:329–33; Clin Gastroenterol Hepatol 2012;10:1246–52; Inflamm Bowel Dis 2014;20:1091–8]

Findings of the present study highlight the importance of increased surveillance during pregnancy and delivery in the population of women with JIA, researchers said.

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Most Read Articles
27 Nov 2017
Transdermal oestradiol added to progesterone reduces menopause-related depression, researchers reported at the annual meeting of The North American Menopause Society in Philadelphia, US.
3 days ago
Intravenous (IV) iron is less toxic and more effective compared to oral iron, making it a potential frontline therapy for neonatal iron deficiency anaemia, suggests a recent study.
Tracy TC Kwan, BSc (Nursing), MPH; Hextan YS Ngan, MBBS, FHKAM (O&G), MD (HK), FRCOG, 01 Aug 2013

Human papillomavirus (HPV) infection is a prevalent disease worldwide. Consequences of HPV infection vary, depending on the infected individuals and the HPV genotype involved. Life-threatening consequences are not uncommon, and cervical cancer is a clear demonstration of the virus’s potency. While the incidence of cervical cancer is heavily concentrated on developing countries,1 the impact of HPV-related diseases on developed countries has not ceased. In the United States alone, HPV infections are the most common sexually transmitted disease with an estimated 5 million new cases being diagnosed in 2000 among young adults, incurring nearly US$3 billion in terms of direct medical costs.2 A multinational study involving 18,498 women showed that cervical HPV prevalence varied greatly geographically, ranging from the low of 1.6% in North Vietnam to the high of 27% in Nigeria. In general, HPV prevalence peaked among young, sexually active women and declined with age. In selected countries, however, a second peak was noted in women older than 55 years.3 The high prevalence of HPV-related diseases incurs a heavy burden on the healthcare systems of developed and developing countries alike, which renders HPV research and prevention a global public health imperative. On an individual level, the afflictions caused by HPV-related diseases go beyond that of physical suffering to affecting the psychological well-being of the infected. This is the focus of our paper.

27 Nov 2017
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic HBV infection is probably the most common maternal infection encountered in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of the endemic areas, immunisation against HBV was first provided in 1983 to infants born to mothers who were screened positive for hepatitis B surface antigen (HBsAg). Immunisation became widespread since November 1988, but HBsAg-positive mothers are still encountered frequently.1