Disease activity, corticosteroid use linked to preterm delivery risk in women with RA
medwireNews: Study findings indicate that disease activity and corticosteroid use may contribute to the elevated risk of preterm delivery among pregnant women with rheumatoid arthritis (RA).
As reported in Arthritis Care & Research, 657 women with RA who participated in the OTIS Autoimmune Disease in Pregnancy Project had approximately double the risk of delivering their baby before 37 gestational weeks than 564 controls without arthritis, at rates of 16.3% versus 7.8% (risk ratio [RR]=2.09).
Women who had active RA – defined as a Patient Activity Scale (PAS) score of more than 3.70 points – prior to 19 gestational weeks and at any time during pregnancy had a significantly higher risk of preterm delivery than those with a lower PAS score, with RRs of 1.58 and 1.52, respectively, after multivariable adjustment for factors including maternal age, smoking and corticosteroid use during the first trimester.
Furthermore, corticosteroid use during any trimester of pregnancy was associated with an approximate twofold increased risk of preterm delivery independently of disease activity (adjusted RR=1.86–2.13) among patients with RA, report Chelsey Smith (University of California San Diego, USA) and fellow researchers.
“Reassuringly, neither DMARDs nor biologic medications used in any trimester were independently linked to higher risk of [preterm delivery]”, they add.
The researchers also analysed data from 170 pregnant women with juvenile idiopathic arthritis (JIA), who likewise had a significantly increased risk of preterm delivery compared with the healthy controls (RR=1.81). Corticosteroid use during any trimester was significantly associated with preterm delivery risk among the JIA patients (adjusted RR=3.37–4.90), but active disease was not.
The study authors caution, however, that the “heterogeneous nature of our JIA cohort”, with an unknown breakdown of JIA subtypes, “may have rendered the disease activity measures less reliable.” Moreover, they point out that the study was limited by the small number of JIA patients.
Smith and colleagues identified some associations between pregnancy complications and preterm delivery risk among patients with RA and JIA. For example, RA patients with preeclampsia, placenta previa and/or placental abruption, gestational diabetes or pregnancy-induced hypertension had a significantly elevated risk, as did JIA patients with fever during pregnancy. On the other hand, with the exception of placenta previa and/or placental abruption, these factors were not significantly associated with preterm delivery risk among the healthy controls.
These findings suggest that complications during pregnancy “may have differential influence on PTD risk in the inflammatory arthritis population compared to the general population of pregnant women”, concludes the team.
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