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...
BackgroundVery little has been published about psoriatic arthritis (PsA) in pregnancy, and it remains unknown whether pregnancy outcomes are impacted by this disease or whether disease activity is changed by pregnancy or delivery.ObjectivesTo discover the rate of pregnancy complications for women with psoriatic arthritis, and to determine whether psoriasis and the associated arthritis change during and following pregnancy.MethodsA retrospective survey was completed by 40 women aged 20–50 years with psoriatic arthritis managed at a university center. Each survey collected information about infertility, pregnancy outcomes and complications, as well as patient-reported assessments of changes in both skin and joint disease activity at the onset of pregnancy, over the course of the pregnancy, and in the months following pregnancy. Simple statistics were used to compare outcomes before and after the diagnosis of PsA.ResultsThe survey was completed by 40 women with PsA. The majority (93%) were white, non-Hispanic with a high level of education (40% completed college and another 30% either started or finished a graduate degree); 62.5% were married. The average age at the time of the study was 37.4 (SD 7.9) years and age at PsA diagnosis was 30.9 (8.4) years.Twenty-five women reported they had ever tried to become pregnant, and of those, 9 had been unable to become pregnant after 12 months of trying or had been diagnosed with infertility by a physician (36%). The reasons for infertility or inability to become pregnant included polycystic ovarian syndrome (44%), problem with ovulation (11%), problem with uterus (11%), elevated prolactin (11%), infection in pelvic area (11%), and/or cervical problems (30%). Infertility was unexplained in 33%.There were 70 pregnancies to 26 patients, with 37 pregnancies occurring after the diagnosis of PsA (see table). Pregnancy outcomes following PsA diagnosis were worse than those prior to PsA diagnosis, particularly the rate of pregnancy loss (32% compared to 12%; p=0.05) and preterm birth (48% compared to 21%; p=0.02). Only 24% of patients took psoriasis or arthritis medications during pregnancy. The most commonly used medications during pregnancy were TNF inhibitors (16%), corticosteroids (8%), and DMARDs (5%).The large majority of patients had minimal arthritis and psoriasis during pregnancy. Only 12% had moderate and 6% had severe arthritis. Similarly, only 10% had moderate and 7% had severe psoriasis. During and following pregnancy, about half of all patients reported no change in either joint or skin activity during and follow pregnancy, with fairly equal numbers reporting improved and worsened arthritis. On the other hand, 42% had improved psoriasis during pregnancy compared to 6% with worsened. There did not appear to be a significant postpartum flare.ConclusionsOur analysis found that among women with PsA who have tried to become pregnant, 36% experienced infertility, primarily due to PCOS. Compared to pregnancies occurring before the diagnosis of PsA, pregnancies after PsA diagno...
BackgroundData suggest infertility is increased in women with rheumatoid arthritis (RA) compared to healthy women. Therefore, it is possible that diminished ovarian reserve and ovulatory dysfunction may be more common among women with RA.ObjectivesTo compare differences in ovarian reserve and ovulatory frequency, as well as in self-reported infertility, between women with and without RA.MethodsWomen with RA aged 20–40 seen in a university clinic without a history of ovarian surgery or prior exposure to possible ovary-toxic medications were invited to participate in a cross-sectional survey. Healthy controls were women aged 20–40 without an autoimmune disease, matched for age and current use of hormonal contraceptives. Infertility was defined as a patient reporting physician-diagnosed infertility or being unable to get pregnant after 12 months of trying. Ovarian reserve was assessed by measuring anti-Müllerian hormone (AMH). In women who were not taking hormonal contraceptives, progesterone level was measured from a serum sample drawn between days 21 and 23 of the menstrual cycle. Anovulation was defined as a progesterone level <3 ng/mL. In descriptive comparisons, differences in proportions were determined by Fisher's exact test, and ANOVA determined differences in means for continuous variables. Multivariate linear models estimated the effect of RA on AMH. In women with RA, the effect of RA medication use on AMH and anovulation was explored.ResultsThere were 75 RA patients (83% Caucasian, 4% Hispanic, 77% with at least a college education) and 75 controls (64% Caucasian, 5% Hispanic, 88% with at least a college education). The majority of RA patients were married (60%), compared to 31% of controls. The mean age of both RA patients and controls was 32 years. Mean AMH in RA patients was 3.0 (SD: 2.6) compared to 3.9 (SD: 3.9) in controls (p-value: 0.1). In linear regression models adjusted for age, hormonal contraceptives and race (nonwhite vs. white), RA patients had a lower AMH than healthy controls (β: -1.05; 95% CI: -2.09, -0.005; p=0.05). There was no observed difference in the proportion of RA patients and controls with anovulation (19% in RA and 21% in controls). Infertility was reported by 12% of RA patients and 7% of controls (p=0.4).Among RA patients, 81% reported having ever used methotrexate (MTX). The mean AMH for MTX users was 2.8 (SD: 2.4) compared to 4.0 (SD: 3.1) in never users (p=0.1). In linear regression models adjusted for age, hormonal contraceptives and race, RA patients who had ever taken MTX had a lower AMH than those who had never taken MTX (β: -1.49; 95% CI: -2.83, -0.15; p=0.03). However, when the cumulative dose of MTX was analyzed, there was no effect of cumulative MTX and AMH. Ever use of prednisone or NSAIDs did not appear to affect AMH levels in RA patients. Methotrexate, prednisone, and NSAIDs use did not have an observed effect on anovulation.ConclusionsIn this cross-sectional study, women with RA appeared to have a lower AMH level than healthy controls, suggesting ovarian reserve...
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