High Rate of Preterm Birth in Pregnancies Complicated by Rheumatoid Arthritis

Abstract

Objective To describe the outcomes of pregnancies complicated by rheumatoid arthritis (RA) and to estimate potential associations between disease characteristics and pregnancy outcomes.

Study Design We reviewed all pregnancies complicated by RA delivered at our institution from June 2001 through June 2009. Fisher exact tests were used to calculate odds ratios. Univariable regression was performed using STATA 10.1 (StataCorp, College Station, TX). A p value of ≤ 0.05 was considered statistically significant.

Results Forty-six pregnancies in 40 women were reviewed. Sixty percent of pregnancies had evidence of disease flare and 28% delivered prior to 37 weeks. We did not identify associations between preterm birth and active disease at conception or during pregnancy. In univariate analysis, discontinuation of medication because of pregnancy was associated with a significantly earlier gestational age at delivery (36^2/7 versus 38^3/7 weeks, p = 0.022).

Conclusion Women with RA may be at higher risk for preterm delivery.

Keywords

pregnancy - rheumatoid arthritis - preterm birth - medication use in pregnancy

• References

• 1 Symmons DP, Barrett EM, Bankhead CR, Scott DG, Silman AJ. The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register. Br J Rheumatol 1994; 33: 735-739
• 2 Gabriel SE. The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am 2001; 27: 269-281
• 3 Golding A, Haque UJ, Giles JT. Rheumatoid arthritis and reproduction. Rheum Dis Clin North Am 2007; 33: 319-343 , vi–vii
• 4 Hench PS. The ameliorating effect of pregnancy on chronic atrophic (infectious rheumatoid) arthritis, fibrositis and intermittent hydrarthritis. Mayo Clin Proc 1935; 13: 161-167
• 5 Nelson JL, Ostensen M. Pregnancy and rheumatoid arthritis. [review] Rheum Dis Clin North Am 1997; 23: 195-212
• 6 Barrett JH, Brennan P, Fiddler M, Silman AJ. Does rheumatoid arthritis remit during pregnancy and relapse postpartum? Results from a nationwide study in the United Kingdom performed prospectively from late pregnancy. Arthritis Rheum 1999; 42: 1219-1227
• 7 de Man YA, Hazes JMW, van der Heide H , et al. Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum 2009; 60: 3196-3206
• 8 Nørgaard M, Larsson H, Pedersen L , et al. Rheumatoid arthritis and birth outcomes: a Danish and Swedish nationwide prevalence study. J Intern Med 2010; 268: 329-337
• 9 Reed SD, Vollan TA, Svec MA. Pregnancy outcomes in women with rheumatoid arthritis in Washington State. Matern Child Health J 2006; 10: 361-366
• 10 Chakravarty EF, Nelson LM, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum 2006; 54: 899-907
• 11 Lin HC, Chen SF, Lin HC, Chen YH. Increased risk of adverse pregnancy outcomes in women with rheumatoid arthritis: a nationwide population-based study. Ann Rheum Dis 2010; 69: 715-717
• 12 Förger F, Østensen M, Schumacher A, Villiger PM. Impact of pregnancy on health related quality of life evaluated prospectively in pregnant women with rheumatic diseases by the SF-36 health survey. Ann Rheum Dis 2005; 64: 1494-1499
• 13 de Man YA, Hazes JM, van de Geijn FE, Krommenhoek C, Dolhain RJ. Measuring disease activity and functionality during pregnancy in patients with rheumatoid arthritis. Arthritis Rheum 2007; 57: 716-722
• 14 Tita AT, Landon MB, Spong CY , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 2009; 360: 111-120
• 15 Bates E, Rouse DJ, Mann ML, Chapman V, Carlo WA, Tita AT. Neonatal outcomes after demonstrated fetal lung maturity before 39 weeks of gestation. Obstet Gynecol 2010; 116: 1288-1295
• 16 Bowden AP, Barrett JH, Fallow W, Silman AJ. Women with inflammatory polyarthritis have babies of lower birth weight. J Rheumatol 2001; 28: 355-359
• 17 Forrest JD. Epidemiology of unintended pregnancy and contraceptive use. Am J Obstet Gynecol 1994; 170 (5 Pt 2) 1485-1489
• 18 Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006; 38: 90-96
• 19 Chambers C, Koren G, Tutuncu ZN, Johnson D, Jones KL , Organization of Teratology Information Specialist (OTIS) Study. Are new agents used to treat rheumatoid arthritis safe to take during pregnancy? Organization of Teratology Information Specialists (OTIS) study. Can Fam Physician 2007; 53: 409-412
• 20 Østensen M, Förger F. Management of rheumatoid arthritis medications in pregnant patients. Nat Rev Rheumatol 2009; 5: 382-390