Maternal RA tied to increased risk of multiple adverse outcomes

Elaine Soliven
28 Jun 2018
Pregnant women with rheumatoid arthritis (RA) are more likely to have premature delivery or baby of low birth weight compared with women without RA, according to a study presented at EULAR 2018.

Using data from the Taiwan National Health Insurance database and birth registry from 2001–2012, the researchers identified 2,350,339 singleton pregnancies, of whom 845 women had a history of RA. Maternal history of systemic lupus erythematosus, Sjögren’s syndrome, systemic sclerosis, vasculitis, and poly/dermatomyositis were also determined. [EULAR 2018, abstract OP0135]

Results showed that infants born to mothers with RA were more likely to have low birthweight (<2,500 g; odds ratio [OR], 1.65, 95 percent confidence interval [CI], 1.37–1.98; p<0.05), be born prematurely (<37 weeks; OR, 1.41, 95 percent CI, 1.18–1.68; p<0.05), and small-for-gestational-age (OR, 1.62, 95 percent CI, 1.36–1.92; p<0.05) compared with infants with non-RA mothers.

In addition, a higher risk of preterm labour (OR, 1.34, 95 percent CI, 1.06–1.68) was observed in women who had an RA during pregnancy, but there was no increased risk of cardiovascular complications, surgical complications, postpartum mortality, and other systemic organ dysfunction.

The findings are consistent with previous studies which revealed that maternal RA was associated with increased risks of several adverse pregnancy outcomes, such as low-birth-weight infants, premature delivery, intrauterine growth restriction, caesarean delivery, and pre-eclampsia. [Matern Child Health J 2006;10:361-366; J Intern Med 2010;268:329-337; Ann Rheum Dis 2010;69:715-717]

“Our results add to a growing body of evidence from different populations suggesting small but significant increases in prematurity and a decrease in birth weight in pregnancies in mothers with RA,” according to lead author Dr Tsai Yun-Chen from the Division of Rheumatology, Allergy, and Immunology at Chang Gung Memorial Hospital, Taoyuan, Taiwan.

“Pregnancy in patients with RA is very complex as there are many factors clinicians and patients need to consider,” said Professor Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR, who suggested that “more information is needed to understand implications of the disease and treatments on both mother and foetus.”

“[Nevertheless,] women with RA should not be discouraged to seek pregnancy based on the disease alone,” Tsai noted.
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