Association between disease activity of rheumatoid arthritis and maternal and fetal outcomes in pregnant women: a systematic review and meta-analysis

Abstract

Background A meta-analysis has compared the pregnancy outcomes between women with and without RA, while the effect of disease severity on pregnancy outcomes within women with RA has not been explored. Therefore, we performed a systematic review and meta-analysis to assess the association between disease activity of RA and pregnancy outcomes. Methods Four English databases (Pubmed, Embase, Cochrane Library, and Web of Science) and three Chinese databases (China National Knowledge Infrastructure [CNKI], VIP, and Wan Fang) was searched for eligible studies up to August 13, 2023. Cochran’s Q test and the I2 statistic were used to assess the heterogeneity of the included studies. The odds ratio (OR) (for counting data) and weighted mean difference (WMD) (for measurement data) were calculated with 95% confidence intervals (95%CIs) using random-effect model (I2 ≥ 50%) or fixed-effect model (I2 < 50%). Subgroup analysis based on study design and regions was used to explore the sources of heterogeneity. Sensitivity analysis was performed for all outcomes and the publication bias was assessed using Begg’s test. Results A total of 41 eligible articles were finally included. RA women had higher odds to suffer from preeclampsia, gestational diabetes, spontaneous abortion, and cesarean delivery (all P < 0.05). The infants born from RA mother showed the higher risk of stillbirth, SGA, LBW, congenital abnormalities, diabetes type 1, and asthma (all P < 0.05). The high disease activity of RA was significantly associated with the higher risk of cesarean delivery (OR: 2.29, 95%CI: 1.02–5.15) and premature delivery (OR: 5.61, 95%CI: 2.20–14.30). Conclusions High disease activity of RA was associated with the high risk of adverse pregnancy outcomes, suggesting that it was important to control disease for RA women with high disease activity who prepared for pregnancy.

Autoimmune diseases and adverse pregnancy outcomes: an umbrella review

“…A further 17 reviews were excluded due to critically low study quality and overlaps in the included primary studies. Finally, 32 reviews were included in this umbrella review [ 29 , 30 , 32 – 38 , 109 – 131 ]. Figure 1 shows the selection process in accordance with the PRISMA flow diagram.…”

“…Significant association of miscarriage was also observed with coeliac disease (OR 1.38 (1.12–1.69)), rheumatoid arthritis (OR 1.32 (1.21, 1.43)), psoriasis (OR 1.10 (1.01–1.20)), and systemic sclerosis (OR 1.60 (1.29–2.22)) [ 29 , 31 , 109 , 128 ]. No significant association was reported for miscarriage in women with IBD (OR 1.63 (0.49–5.43)) or psoriatic arthritis (OR 1.35 (0.79–2.32)) [ 34 , 128 , 131 ]. One of the studies reported composite outcome of abortion (spontaneous and therapeutic) in pregnant women with SLE (OR 1.40 (1.20–1.60)) [ 110 ].…”

“…High risk was also reported in women with SLE (OR 3.20 (2.54–4.20)) or systemic sclerosis (OR 2.20 (2.21–4.53)) [ 29 , 30 ]. Some association was observed in women with rheumatoid arthritis (OR 1.65 (1.53, 1.78)) or psoriatic diseases (psoriasis OR 1.25 (1.09–1.42), psoriatic arthritis OR 1.45 (1.13–1.85)) [ 31 , 128 , 131 ]. No significant association was noted in women with AxSpA (OR 1.74 (0.85–3.54)), coeliac disease (OR 1.04 (0.87–1.21)), or IBD (OR 4.65 (0.76–28.35)) [ 34 , 38 , 109 , 122 ].…”

“…Lou et al reported similar risk of GDM in both women with only thyroglobulin antibodies (OR 1.88 (1.13–3.12)) and only thyroid peroxidase antibodies (OR 1.65 (1.13–2.40)). No significant association was reported for developing GDM in women with AxSpA (OR 0.88 (0.24–3.21)), psoriatic arthritis (OR 1.26 (0.90–1.77)), rheumatoid arthritis (OR 1.61 (1.25, 2.07)), and SLE (OR 0.97 (0.57–1.60)) [ 31 , 32 , 38 , 128 , 131 ].…”

A vasculitis mimic during pregnancy: autoimmune progesterone dermatitis

“…In November 2021, the National Institute for Health and Care Excellence (NICE) recommended vaginal progesterone in women who experience bleeding in early pregnancy and have a history of miscarriage as it slightly reduces the risk of a further miscarriage [ 2 ]. The new guidelines suggest that more pregnant women with miscarriages will use topical progesterone during pregnancy and given the association between active rheumatic disease and poor pregnancy outcomes [ 6 , 7 ], we may see APD more frequently in our rheumatology practice.…”