medwireNews: Results of an observational study suggest that pregnant women with rheumatoid arthritis (RA) or axial spondyloarthritis (AS) have an elevated risk for pregnancy complications, and disease activity may be a risk factor for preterm delivery.
Therefore, “[t]argeting inactive disease in pregnant patients is important to allow for successful pregnancy and to impede disease progression,” write the study authors in Rheumatology.
Frauke Förger (University of Bern, Switzerland) and fellow researchers found that the 86 women with RA and the 70 with AS had a significantly increased risk for adverse pregnancy outcomes – including premature birth, small for gestational age (SGA) infants, preeclampsia, gestational diabetes – compared with 70 healthy controls.
The strongest association was observed for preterm delivery, with RA patients having a 14-fold increased risk and AS patients having an eightfold increased risk relative to healthy controls after adjustment for maternal age and number of previous pregnancies.
Patients with RA or AS were also significantly more likely to deliver their babies by cesarean section than healthy controls, with adjusted odds ratios (ORs) of 2.2 and 1.8, respectively.
Among the women with RA, 31.3% experienced active disease, defined as a Disease Activity Score at 28 joints based on C-reactive protein (DAS28-CRP) of at least 3.2 points, at any time during pregnancy. In a multivariate analysis, active RA was identified as a significant predictor of preterm delivery (adjusted OR=3.9), but was not significantly associated with other outcomes such as having a SGA infant preeclampsia, or gestational diabetes.
The majority (78.3%) of patients with AS experienced active disease (Ankylosing Spondylitis Disease Activity Score [ASDAS] based on CRP >2.1 points) during the course of pregnancy, most commonly during the second trimester.
Active AS according to the ASDAS score was not a significant predictor of preterm delivery in the multivariate analysis, but there was a significant association between elevated levels of CRP during the second trimester and preterm delivery (adjusted OR=13.8).
Förger and team explain that “ASDAS is a composite index combining four subjective clinical variables and the natural logarithm of the CRP,” whereas “[a]n elevated CRP level is a direct sign known to correlate with more severe disease and with active axial joint inflammation in patients with axSpA.”
Therefore, disease activity is “a risk factor for preterm delivery not only in RA but also in axSpA,” they say.
And the researchers conclude: “Based on a risk–benefit analysis and on a process of shared decision- making with the patient, an effective treatment with pregnancy-compatible drugs should be continued beyond conception.”
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