Pregnancy Outcomes in Women With Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory rheumatic disease affecting multiple joints and can also be a systemic widespread, affecting major organs. Rheumatoid arthritis is associated with greater adverse maternal and neonatal outcomes in comparison to the general obstetric population. This systematic review and meta-analysis aims to investigate the pregnancy outcomes in RA patients in comparison to the general pregnant population.Nine studies involving 11,999 RA patients met the eligibility criteria with 9,921,808 controls. Rheumatoid arthritis patients were compared with their control counterparts according to random-effects model statistical analysis.We searched databases from inception to September 8, 2021. Eligible studies reported maternal outcomes (preeclampsia, cesarean delivery, and preterm delivery) and/or neonatal outcomes. Data were pooled across using random-effects model. Subgroup analysis was conducted on RA patients alone. The review was registered prospectively with PROSPERO (CRD42021250521).In terms of maternal outcomes, there was an increased rate of cesarean delivery (odds ratio [OR], 1.55), preeclampsia (OR, 1.61), and preterm delivery (OR, 1.83) in RA patients compared with their control counterparts. In terms of neonatal outcomes, a higher rate of lower gestational weight (mean difference [MD], −0.19 kg), requirement for neonate intensive care unit admission (OR, 1.34), and stillbirths (OR, 1.99) were observed in RA patients compared with the controls. A subgroup analysis of 4 studies involving only RA patients (n = 3761) was conducted. A total of 33.2% of patients had a cesarean delivery, 7.3% had preeclampsia, 14.8% had a preterm delivery, and 9.5% of neonates had low birth weight.Compared with the general pregnant population, women with RA tend to have a higher risk of maternal and neonatal complications. As a result, this study hopes to increase awareness into the importance of counseling and managing RA patients.

Fetal Growth Associated with Maternal Rheumatoid Arthritis and Juvenile Idiopathic Arthritis

“…Our study also had several findings that have been similarly reported in other studies on this population: patients with RA/JIA in our study have higher rates of C-sections and pre-eclampsia; 6,26,28,35 however the rates of stillborn are the same as individuals without RA/JIA. 6 From our mediation analysis, we found that PEC accounted for only about 4% of fetal growth restriction.…”

“…Our results are consistent with prior studies on pregnancy outcomes among patients with RA/JIA: pregnant patients with RA tend to be older at the time of pregnancy, at higher risk for hypertensive disorders during pregnancy, tend to undergo C-section deliveries, and their offspring are likelier to have restricted fetal growth. 2,15,26 Interestingly, our study found that patients with RA/JIA who used CS or SSZ during pregnancy had higher EFW during the second trimester compared to fetuses of patients without RA/JIA (Table S3). As patients with RA/JIA are at higher risk of early pregnancy losses and subfertility, 27,28 it is plausible that the finding of higher EFW during second trimester among women with RA/JIA was influenced by survivor bias.…”

“…Our results are consistent with prior studies on pregnancy outcomes among patients with RA/JIA: pregnant patients with RA tend to be older at the time of pregnancy, at higher risk for hypertensive disorders during pregnancy, tend to undergo C-section deliveries, and their offspring are likelier to have restricted fetal growth. 2,15,26…”

Global, regional and national temporal trends in prevalence for musculoskeletal disorders in women of childbearing age, 1990–2019: an age-period-cohort analysis based on the Global Burden of Disease Study 2019

“…Pregnancy is an inevitable issue for WCBA at adult stage, and maternal mortality caused by severe pregnancy complications in this population inhibits the realisation of sustainable development goals established by the United Nations. Compared with the general obstetric population, pregnant women with MSK disorders have higher risk in developing adverse maternal, neonatal and fetal outcomes including gestational hypertension, pre-eclampsia, caesarean delivery, preterm delivery, low birth weight, congenital anomalies, stillborn, etc ,29 30 which may be associated with medication use and disease activity 30. Moreover, the flare of MSK disorders may coexist with these complications, and difficulties in differential diagnosis are raised 31.…”

The dichotomy of glucocorticosteroid treatment in immuneinflammatory rheumatic diseases: an evidence-based perspective and insights from clinical practice

“…Glucocorticosteroids are one of the medications commonly used in pregnancy to control IRD disease activity, given that a large number of classical and biologic DMARDs cannot be used due to their teratogenicity and ability to cross the placenta. It was demonstrated in some studies that long-term GC use during pregnancy can be associated with an increased risk of gestational hypertension, pre-eclampsia, and gestational diabetes [61,62]. The use of PDN during pregnancy has been found to increase the risk of premature delivery and, consequently, lower birth weight in pregnant women with RA.…”