Adverse Impact of Rheumatoid Arthritis on Pregnancy Outcomes: A Saudi Arabia Prospective Multicenter Study

Abstract

Background Rheumatoid arthritis (RA) is associated with adverse pregnancy outcomes and postpartum complications, especially with severe disease activity. Objective The current study aimed to compare the pregnancy outcomes in patients with RA and healthy controls as well as to assess the impact of disease-related variables, medications and disease activity on pregnancy and neonatal-related outcomes in the Saudi population. Methods This prospective multicenter study included pregnant female patients with RA from three tertiary centers in Saudi Arabia. The demographics, disease activity scoring (DAS28-CRP), medication before and during pregnancy, pregnancy-related outcomes, and complications in comparison to age-matched healthy female controls were noted. Results A total of 77 pregnant patients with RA and 250 healthy age-matched pregnant controls were included in the study. A total of 67.53% were in remission before conception (DAS28CRP ≤2.6), and 81.8% of pregnancies were planned. Age of conception, preterm labor, neonatal intensive care unit (NICU) admission and low birth weight were statistically significant (p <0.05) and higher in RA patients than in healthy controls. Longer disease duration (p <0.001), and high C-reactive protein and erythrocyte sedimentation rate levels before conception (p ≤0.001) were statistically associated with preterm NICU admission. There was statistically significant association between mild (p = 0.015) or moderate to severe DAS28-CRP (p = 0.001) and RA patients regarding pregnancy outcomes. The classification table obtained from the logistic model showed patients with mild and moderate-severe DAS28-CRP have significantly high chances of having an adverse pregnancy outcome. Conclusion RA has a negative impact on pregnancy-related outcomes. Higher disease activity is considered a major risk; thus, tight disease control should be aimed. Planned pregnancy follow-up is associated with better pregnancy outcomes.

Pregnancy Outcomes in Women With Rheumatoid Arthritis

“…The maternal outcomes of the patients are shown in Figure 1 and Table 1. Maternal age at the time of delivery for those with RA was on average 1.78 years older than controls, 13–15,17 whereas the gestation age was 0.99 weeks earlier 1,14,17 . Frequency of maternal smoking was reported in 8.20% of RA and in 5.12% of controls in 5 of the 9 studies 3,14–17 .…”

“…Preterm birth was reported in 11.45% of RA patients compared with 7.04% of controls (OR, 1.83; 95% CI, 1.55–2.17; I 2 = 67%) 2,3,13–15,17 . Preeclampsia was higher in RA patients (5.66%) compared with controls (4.05%) (OR, 1.61; 95% CI, 1.40–1.86; I 2 = 35%) 1,3,12–17 . Gestational diabetes was reported in 7.40% of RA patients and in 5.64% of controls (OR, 1.37; 95% CI, 1.25–1.50; I 2 = 0%) 3,12,14 …”

“…Results of the quality assessment of all included studies are shown in Supplementary Table 1, http://links.lww.com/RHU/A526. In the RA versus CONS group, 6 studies were judged to be of good quality 1,2,13,14,16,17 . Conversely, 3 studies were judged to be of moderate quality 3,12,15 .…”

“…Frequency of maternal smoking was reported in 8.20% of RA and in 5.12% of controls in 5 of the 9 studies 3,14–17 . Two studies reported medication use prepregnancy such as corticosteroids, NSAIDs, DMARDs, and TNF inhibitors 2,13 . The use of certain rheumatic medications before and during pregnancy were observed to observe any adverse maternal outcomes from certain medication use.…”

“…There was a higher cesarean delivery in RA patients (36.55%) compared with controls (29.55%) (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.36–1.77; I 2 = 78%) 1–3,12,13,15–17 . Preterm birth was reported in 11.45% of RA patients compared with 7.04% of controls (OR, 1.83; 95% CI, 1.55–2.17; I 2 = 67%) 2,3,13–15,17 . Preeclampsia was higher in RA patients (5.66%) compared with controls (4.05%) (OR, 1.61; 95% CI, 1.40–1.86; I 2 = 35%) 1,3,12–17 .…”