Brief Report: Does Medication Use or Disease Activity During Pregnancy in Patients With Rheumatoid Arthritis Affect Bone Density in Their Prepubertal Offspring?

Abstract

Objective. Prednisone use and active disease are associated with reduced bone mineral density (BMD) in patients with rheumatoid arthritis (RA). Either or both of these factors may be inevitable during pregnancy in women with RA, but it is unknown whether they variables influence the BMD of the offspring. This study was undertaken to investigate whether medication use or disease activity during pregnancy in RA patients influences the BMD of their prepubertal offspring.Methods. Mothers (n ‫؍‬ 255) participated in a prospective cohort study of RA and pregnancy, and 108 children of these mothers (ages 5-10 years) were included in this followup study. Information on features known to influence BMD in children, i.e., calcium intake, physical activity, serum 25-hydroxyvitamin D level, sex, height, and weight, was collected. In addition, pre-and postnatal variables known to influence BMD, i.e., gestational age, maternal smoking, birth weight, postnatal rate of growth, and type of feeding, were recorded. Independent variables were prednisone use, sulfasalazine use, and RA disease activity during pregnancy.Results. We found no association of BMD in the children with either prednisone use or RA disease activity during pregnancy, even after correcting for all known associated variables. Sulfasalazine use during pregnancy had a positive effect on the total-body BMD of the offspring (difference in standard deviation score 0.53, P ‫؍‬ 0.005).Conclusion. Our findings indicate that neither medication use nor high RA disease activity during pregnancy is associated with decreased BMD in offspring at age ϳ7 years. The maternal benefit of medication use for RA during pregnancy outweighs the effect on BMD in the offspring.

Associations between antenatal prednisone exposure and long-term cortisol and cortisone concentrations in children born to women with rheumatoid arthritis: results from a nationwide prospective cohort study

“…In our study, we did not explore the effect of antenatal prednisone exposure on the BMD of the offspring. However, in a previous study by de Steenwinkel et al ,55 they investigated the influence of medication use and disease activity of the mother during pregnancy on the offspring at the age of approximately 7 years. In that study, a dual x-ray absorptiometry scan was performed in 108 children born to women with RA.…”

Osteoporosis in Black South Africans With Rheumatoid Arthritis

“…This may be explained by better disease activity control although this was not reflected by the ESR or the DAS-28 ESR. Although a study of children whose mothers were treated with sulphasalazine had higher total body bone mineral density (BMD) [23], other studies have not shown any association between MTX either alone or in combination with other DMARDs and incident fractures or BMD [24]. We postulate that this may be because disease activity measures were taken at one point in time rather than an average value over time.…”

Nutrients, Diet, and Other Factors in Prenatal Life and Bone Health in Young Adults: A Systematic Review of Longitudinal Studies

“…We were surprised at the absence of studies that examined a range of other factors that could potentially influence offspring bone health in a life course perspective. Among the factors that have not been adequately addressed, except for in animal models, are prenatal exposure to, e.g., infections (e.g., cystitis); prolonged pregnancy; hyperemesis gravidarum; maternal use of medication during pregnancy, i.e., corticosteroid [43][44][45][46] or selective serotonin reuptake inhibitors [47]; endocrine disruptive chemicals [48][49][50][51]; and estradiol concentrations [52,53]. Moreover, we did not detect any studies that examined the influence of either insulin resistance during pregnancy or gestational diabetes on bone health among adult offspring.…”