Increased risk for preterm delivery in women with RA and JIA
medwireNews: Women with rheumatoid arthritis (RA) and those with juvenile idiopathic arthritis (JIA) have a significantly elevated risk for preterm delivery (PTD), according to a prospective cohort study published in Arthritis Care & Research.
Compared with women without autoimmune disease, those with RA had a 2.09-fold increased risk for PTD (<37 gestational weeks), while the risk was increased 1.81-fold in those with JIA. In the case of women with RA, active disease (defined as a Patient Activity Scale score >3.70), both at the time of enrolling into the study and at any time during pregnancy, was also significantly associated with an increased risk for PTD, with risk ratios of 1.58 and 1.52, respectively, after adjustment for factors including maternal age, race, and BMI.
Discussing this finding, Chelsey Smith (University of California San Diego, USA) and study co-authors note that while the increased PTD rate might be expected to result from greater corticosteroid use to control disease flares, the significant association between disease activity and PTD remained even after adjustment for first trimester corticosteroid use. This, they say, implies “that active disease in RA may contribute to PTD independent of medications.”
Nonetheless, corticosteroid use itself was associated with a 1.86- to 2.13-fold increased risk for PTD in women with RA and a 3.37- to 4.90-fold increased risk in those with JIA in every trimester, independent of disease activity. Such an association was not found for biologics or conventional DMARDs, a finding that the researchers describe as “reassuring.”
The analysis used data from the Organization of Teratology Information Specialists (OTIS) Autoimmune Disease in Pregnancy Project, and included 657 US and Canadian women with RA, 170 with JIA, and 564 women without autoimmune disease who delivered at least one live-born infant from 2004 to 2017.
Within this population, the researchers also found that pre-eclampsia, pregnancy-induced hypertension without pre-eclampsia, and gestational diabetes were independently associated with a significantly higher risk for PTD among women with RA, but not among those with JIA or those without autoimmune disease. And in women with JIA, the risk for PTD was significantly elevated among those with fever during pregnancy. This highlights that certain factors “may have differential influence on PTD risk in the inflammatory arthritis population compared to the general population of pregnant women,” say the researchers.
And they conclude that further studies are now needed to look at other types of arthritis that affect women of childbearing age, and other factors that might influence the risk for PTD in these women.
By Catherine Booth
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