Pregnancy in juvenile idiopathic arthritis: maternal and foetal outcome, and impact on disease activity

Abstract

Objective: This retrospective cohort study describes the modulation of disease activity during gestation and in the year following delivery as well as maternal and neonatal outcomes in a monocentric cohort of women with juvenile idiopathic arthritis (JIA). Methods: Disease activity was assessed using DAS28-CRP before conception and every 3 months during pregnancy and in the first year postpartum. The risk of complicated pregnancies was measured applying a generalized estimating equation model. Changes in disease activity during gestation and in the first year postpartum were assessed in a linear mixed model for repeated measures. Results: Thirty-one women (49 pregnancies) with persisting JIA and at least one conception were enrolled. Adjusted DAS28-CRP levels remained stable from preconception through the first trimester, but increased significantly in the second and decreased not significantly in the third. In the postpartum, adjusted disease activity peaked at 3 months after delivery, stabilized at 6 months to decrease at 1 year, although not significantly. Preconceptional DAS28-CRP and number of biological drugs predicted disease activity fluctuation during gestation. The number of biological drugs and the length of gestational exposure to biologics significantly predicted pregnancy morbidity. In particular, JIA women had a higher probability of preterm delivery compared with healthy and disease controls. Adjusted for breastfeeding and DAS28-CRP score in the third trimester, postconceptional exposure to biologics was inversely related with disease activity in the postpartum: the longer the patient continued treatment, the lower the probability of experiencing an adverse pregnancy outcome. Conclusion: These data offer novel insights on how treatment affects disease activity during pregnancy and postpartum as well as obstetric outcomes in women with JIA.

Fetal Growth Associated with Maternal Rheumatoid Arthritis and Juvenile Idiopathic Arthritis

“…This is supported by prior studies which reported an association between adverse pregnancy outcomes and high clinical disease activity in patients with inflammatory arthritis. 7,15,33,34 Our study also had several findings that have been similarly reported in other studies on this population: patients with RA/JIA in our study have higher rates of C-sections and pre-eclampsia; 6,26,28,35 however the rates of stillborn are the same as individuals without RA/JIA. 6 From our mediation analysis, we found that PEC accounted for only about 4% of fetal growth restriction.…”

“…This is supported by prior studies which reported an association between adverse pregnancy outcomes and high clinical disease activity in patients with inflammatory arthritis. 7,15,33,34…”

Preterm birth, preeclampsia, gestational hypertension and offspring birth weight in women with active juvenile idiopathic arthritis and healthy controls

“…Women with JIA had stable low disease activity or inactive disease in pregnancy. This has also been demonstrated in other cohorts of pregnant women with JIA the last decades (12,13,(25)(26)(27). A possible association with active JIA in pregnancy has been investigated in two earlier studies, with conflicting results (13,17).…”

Immunology of pregnancy and reproductive health in autoimmune rheumatic diseases. Update from the 11th International Conference on Reproduction, Pregnancy and Rheumatic Diseases

“…The research interest about reproductive issues in women with JIA has flourished only over the recent years, explaining why available data regarding obstetric and neonatal outcomes in JIA are still scanty and not consistent. Discrepancies concern the fluctuation of JIA disease activity during pregnancy: earlier studies suggested improvement of disease activity during gestation [21,33,80], while more recent investigations have reported a high rate of flares during gestation [81][82][83][84][85]. In particular, the latter have shown that disease activity remains substantially stable in the first trimester to significantly increase in the second trimester.…”

“…Indeed, most data come from population-based studies analysing administrative health databases or hospital discharge records, which do not allow for adequate accounting for potential confounders, including JIA category. According to available reports, disease activity tends to peak again in the post-partum [33,80,[83][84][85]; it is important to note that the sooner bDMARDs are reintroduced after delivery, the sooner disease control is obtained [84]. There is a substantial consensus in literature reporting preterm delivery and low neonatal birth weight as the main obstetric complications among JIA women [84,[86][87][88][89][90][91], while data about the risk of PE in JIA pregnancies are conflicting [80,84,90,92,93].…”