Increased surveillance recommended for pregnant women with JIA
medwireNews: Women with a juvenile idiopathic arthritis (JIA) diagnosis are at increased risk for both maternal and infant complications during pregnancy and birth, show data from a nationwide Swedish study.
The increased risks were present in women with JIA confined to childhood as well as those with JIA persistent into adulthood, but were generally more pronounced in the latter group, say the researchers.
“Pregnancies in women with JIA should thus be subject to increased surveillance during pregnancy and delivery,” Katarina Remaeus and colleagues, from Karolinska University Hospital and Institutet in Stockholm, remark.
Remaeus and team compared the outcomes of 1169 births in women with JIA confined to childhood and adolescence (pediatric only JIA) and 638 births in women with JIA persisting into adulthood with those of 1,949,202 population control births.
They found that, compared with the general population, women with JIA were at increased risk for preterm birth, and medically indicated preterm birth in particular, for which the risk was increased 1.74-fold for women with pediatric only JIA and 4.12-fold for women with JIA persisting into adulthood, after adjusting for maternal age at delivery, parity, body mass index, calendar year of birth, smoking habits, educational level, and the mother’s country of birth. The corresponding event rates were 2.2% and 5.2% versus 1.5% for the general population.
JIA persisting into adulthood was also associated with significantly higher rates of moderately preterm birth (32 weeks to 36 weeks and 6 days; 9.3 vs 4.3%; adjusted odds ratio [aOR]=2.27), very preterm birth (<32 gestational weeks; 1.9 vs 0.7%; aOR 3.14), spontaneous preterm birth (5.8 vs 3.5%; aOR 1.63), and small for gestational age birth (4.4 vs 2.6%; aOR 1.84).
Early- and late-onset pre-eclampsia (before and after 34 weeks of gestation) were significantly more common in the women with JIA persisting into adulthood than those of the general population, at aORs of 6.28 (1.4 vs 0.3%) and 1.96 (5.2 vs 2.6%), respectively, but there was no increased risk among the women with pediatric only JIA.
Cesarean sections were more common among both groups of women with JIA relative to the population controls, with an aOR of 1.42 for those with pediatric only JIA and 2.47 for those with JIA persisting into adulthood, and respective rates of 17.0% and 29.3% versus 14.4%. The researchers note that the associations were stronger for elective than for emergency cesarean sections and both groups also had an increased risk for induction of labor.
Remaeus and team suggest that increased rates of pre-eclampsia may contribute to the increased rate of induction of labor or cesarean section in women with JIA persisting into adulthood, particularly as 45.5% of medically indicated preterm births also had pre-eclampsia.
They did not, however, find any association between JIA and neonatal death, stillbirth, or low Apgar score, regardless of persistence into adulthood.
The authors conclude in the Annals of Rheumatic Diseases: “The adverse outcomes seen in our study, more pronounced in JIA persisting [into adulthood], may be due to several factors including disease activity or medication during pregnancy.”
By Laura Cowen
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