SAT0119 Pregnancy outcomes in women with and without rheumatoid arthritis

Abstract

BackgroundPrior studies have suggested higher rates of preterm birth in pregnancies to women with rheumatoid arthritis.ObjectivesWe sought to identify differences in the pregnancy outcomes of women with and without RA, and pregnancies that occurred prior to and following RA diagnosis.MethodsA cross-sectional survey was completed by 75 women with RA age-matched to 75 women without RA. Information collected about each prior pregnancy included: pregnancy outcome (spontaneous abortion, stillbirth, elective termination, ectopic pregnancy, or live birth); the timing of delivery; infant anomalies; methotrexate exposure in pregnancy; and whether the pregnancy was planned. Simple statistics were used to compare pregnancy outcomes between women with and without RA and pregnancies prior to and following RA diagnosis.ResultsThe majority of women with RA (83%) and controls (64%) were white, and 11% of women with RA and 28% of controls were African American. About half of controls and 31% of women with RA had education beyond college. The average age at the time of the survey was 32 years (SD: 5) in both RA patients and controls, and the average age at RA diagnosis was 23 years (SD: 10). There were 76 pregnancies in 40 women with RA and 99 pregnancies in 33 healthy controls (see table). The overall rates of live birth, spontaneous abortion, and ectopic pregnancies were similar between groups; there were no stillbirths.The rate of elective termination was significantly different, with 9% of RA and 30% of control pregnancies terminated (p=0.005). The large majority of the terminations in women with RA occurred prior to diagnosis. The higher frequency of unplanned pregnancy among the controls (38% unplanned RA vs 67% unplanned controls, p=0.0002) likely contributed to this higher termination rate. Of unplanned pregnancies, 45% were terminated in controls, 33% in pre-RA pregnancies, and 9% in post-RA pregnancies. No planned pregnancies were terminated. Three pregnancies in women with RA were exposed to methotrexate (2 unplanned, 1 planned) resulting in 2 spontaneous abortions and 1 live birth, born at term without any reported abnormalities.The rates of preterm birth and infant abnormalities did not differ significantly between those with and without RA, though among women with RA, all preterm births and infant abnormalities occurred after RA diagnosis. Each of the RA preterm births was delivered between 31–34 weeks gestation. Preeclampsia was more common in women with RA, but did not differ significantly between pregnancies prior to and after RA diagnosis.A total of 41% of the post-RA pregnancies had an adverse pregnancy outcome (miscarriage, preterm delivery, or infant abnormality), compared to 13% of pre-RA pregnancies (p=0.01) and 20% of control pregnancies (p=0.01).ConclusionsWomen with RA, overall, had similar rates of miscarriage, stillbirth, and ectopic pregnancy compared to healthy women, but pregnancies that occurred after RA diagnosis had higher rates of these adverse outcomes. More pregnancies in women with RA were plan...

EPEK: Creation and analysis of an Ectopic Pregnancy Expression Knowledgebase

“…Rheumatoid arthritis (RA) is known to be an auto-immune disease where the pathogenesis is attributed to the signaling pathways of different cytokines [48][49][50]. In the context of RA associated with pregnancy, Clowse et al [51] reported that women with pregnancies after being diagnosed with RA have higher rates of pregnancy related adverse outcomes such as miscarriage, stillbirth or ectopic pregnancy. Additionally, there are reports suggesting that pro-inflammatory cytokines are a risk factor for EP [52].…”

The Journey to Motherhood in Chronic Rheumatic Diseases

“…While there are limited data on the incidence of postpartum flares in axSpA, evidence suggests that postpartum disease activity worsens in up to 46% of women with RA or psoriatic arthritis. 27,28 Many women with inflammatory arthritis wish to breastfeed and it is important that they hear from their physicians that most anti-rheumatic medications are considered safe with breastfeeding.…”

Sp0148 does Pregnancy Really Ameliorate Disease Activity of Women With Chronic Arthritis? Old Beliefs vs New Paradigms

“…But even if they were present in breastmilk, bDMARDs will be degraded in the newborn's digestive tract with no chance for absorption (consider that bDMARDs are administered intravenously or subcutaneously, not orally). CTZ was shown to be absent in the breastmilk and breastfed children did not show any particular adverse event [17]. The exposure to immunosuppressive drugs, especially to bDMARDs, during late pregnancy poses the question about the immune competence of the neonate and the approach towards vaccinations.…”