Fetal Growth and Preterm Birth in Children Exposed to Maternal or Paternal Rheumatoid Arthritis: A Nationwide Cohort Study

Abstract

Objective To assess indicators of fetal growth and risk of preterm birth in children of parents with rheumatoid arthritis (RA). Methods Through linkage of Danish national registries we identified all children born in Denmark between 1977 and 2008. We used general linear regression models to estimate mean differences in indicators of fetal growth among children having a parent with RA compared to unexposed children. Odds ratios of preterm birth were calculated by a logistic regression model. Results Of the 1,917,723 children included, a total of 13,556 children were exposed to maternal RA or maternal preclinical RA. Children exposed to maternal RA (2,101) had approximately similar length, head and abdominal circumference at birth, compared with children of mothers without RA. Birth weight was 87 gram lower (−87.04 g; 95% CI, −111.23; −62.84) and placenta weight was 14 gram lower (−13.45 g; 95% CI, −21.46; −5.43). Rather similar results were found in children exposed to maternal preclinical RA (11,455). Compared with unexposed children a higher risk of preterm birth was found in children exposed to maternal RA and maternal preclinical RA respectively (OR, 1.48; 95% CI,1.20;1.84 and OR, 1.32; 95% CI,1.07;1.64). No associations were found with paternal RA. Conclusion Children exposed to either maternal RA or maternal preclinical RA are more often born preterm. However, indicators of fetal growth measured at birth were only slightly lower than in unexposed children.

Early, Incomplete, or Preclinical Autoimmune Systemic Rheumatic Diseases and Pregnancy Outcome

“…Moreover, compared with controls, and after correction for multiple comparisons, moderate/severe complications of pregnancy were significantly more common only in the group of cases with persistence of rheumatic symptoms. A large, epidemiologic, population-based retrospective study in Denmark found that children exposed to preclinical maternal rheumatoid arthritis were more often born preterm and with a placental and neonatal weight lower than that recorded among unexposed controls (31). Finally, the so-called non-criteria APS, that is the presence of incomplete clinical and/or laboratory manifestation of APS, is associated with an increased risk of pregnancy complications, such as recurrent fetal loss and adverse pregnancy outcomes mediated by placental insufficiency (25).…”

Parental rheumatoid arthritis and long-term child morbidity: a nationwide cohort study

“…Previous studies have linked maternal RA with preterm birth [3-8] and low birth weight [5,6,8-11]. These associations could be caused by fetal programming induced by the disease, prenatal exposure to RA treatment or be related to genetic factors.…”

Pregnancy outcomes following exposure to abatacept during pregnancy

“…RA must be controlled while patients are attempting to conceive, and time to conception is longer in those with higher disease activity [27]. In addition, patients with RA are more likely to have preterm births [28]. Elevated disease activity during pregnancy is associated with rapid postnatal catch-up growth in offspring, a risk factor for cardiovascular disease in adulthood [29].…”