Timing of Pregnancy in Relation to the Onset of Rheumatoid Arthritis

Abstract

The interval between the onset of rheumatoid arthritis (RA) and the most recent pregnancy prior to RA onset in 88 women was determined. These data were compared with data obtained from a group of 144 age-matched normal women (controls) who had been assigned a "dummy date for RA onset" for the purposes of analysis. The frequency of disease onset during 3 time intervals within the period from conception to 1 year postpartum was compared with the frequency of disease onset outside this period. There was a reduction in the incidence of disease onset during pregnancy (adjusted odds ratio [OR] 0.30, 95% confidence interval [CI] 0.W2.6) and a numerically greater increased risk of RA onset during the first 3 months postpartum (OR 5.6, 95% CI 1.8-17.6), which persisted for the subsequent 9 months (OR 2.6, 95% CI 0.8-7.9). A reduction in the incidence of disease onset was seen during all pregnancies; in contrast, the postpartum increase was greater in those with RA onset after the first pregnancy. The reduced incidence of RA onset during pregnancy, with the increased risk postpartum, mirrors the previously described suppression of disease activity during preg nancy and the subsequent flare postpartum in women with established RA. In addition, the increased postpartum risk after the first pregnancy might suggest that in susceptible women, either the hormonal changes or the

The treatment of rheumatoid arthritis during pregnancy

“…The postpartum period is also a common time for women to present for the first time with rheumatoid arthritis [3]. Therefore, many pregnant women with rheumatoid arthritis will require some form of treatment to ameliorate their disease during pregnancy and the postpartum period, and it is important to be aware of the treatments that are safe during pregnancy and those that are not.…”

Pregnancy and autoimmune connective tissue disorders

“…Disease flares are observed in a significant proportion of women in the postpartum period. The postpartum stage is also recognised as a high risk period for the initial presentation of RA and this risk is highest following the first childbirth 30 . Though breastfeeding is suggested as a risk factor for disease exacerbations thought to be mediated by mechanisms related to elevated prolactin levels, such hypotheses lack definitive evidence.…”

Os benefícios da amamentação para a saúde da mulher

“…There are evidences that hormonal alterations in the perinatal period could be associated with the disease, since it does not occur during pregnancy, being more common during the postnatal period. 26 Therefore, the prevalent factors during the reproductive cycle needs to be further investigated.…”

“…10,[18][19][20][21][22] There are also evidences that breastfeeding reduces the risk of death from rheumatoid arthritis. [23][24][25][26][27] Many studies have presented the relationship between breastfeeding and postnatal amenorrhea, and the occurrence of a consequent longer intergestational period. 10,[28][29][30][31][32][33][34][35][36][37][38][39][40][41] Other benefits for lactating women are the faster loss of weight gained during the pregnancy, [38][39][40][42][43][44][45] and the reduced postnatal uterine bleeding, which leads to less anemia 10 due to the faster uterus involution caused by the greater oxytocin release.…”