abstract details

The summaries are free for public use. ARTHROS will continue to add and archive summaries of articles deemed relevant to ARTHROS by our Faculty.

A Population Level Analysis of the Differing Impacts of Rheumatoid Arthritis and Spondyloarthritis on Peripartum Outcomes

Author

Keeling S1, Bowker S1, Savu A1, Kaul P1. J Rheumatol. 2019 May 1. pii: jrheum.181320. doi: 10.3899/jrheum.181320. [Epub ahead of print]

Author Information

1 From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada. Address correspondence to Dr. Stephanie Keeling, Department of Medicine, University of Alberta, 8-129 Clinical Sciences Building, Edmonton, Alberta, T6G 2G3 Canada. E-mail: stephanie.keeling@ualberta.ca.

Abstract

OBJECTIVE: 

The impact of rheumatoid arthritis (RA) and spondyloarthritis (SpA) on maternal and neonatal outcomes at a population level has not previously been well compared.

METHODS: 

A contemporary pregnancy cohort of 312,081 women and corresponding birth events was assembled for the province of Alberta from the random selection of one live birth event per woman. We identified three groups: (1) no inflammatory arthritis (no IA, N=308,989), (2) RA (N=631), and (3) SpA (N=2,461). We compared maternal and neonatal outcomes, co-morbid conditions and medication use between the three groups. Multivariable logistic regression models evaluated the independent association between RA and SpA, relative to no IA, and the outcomes of small for gestation age (SGA) and hypertensive disorders during pregnancy.

RESULTS: 

Pregnant women with RA were significantly more likely to have pre-term deliveries (13.5%), caesarean sections (33.9%), hypertensive disorders in pregnancy (10.5%) and SGA babies (15.6%), compared to pregnant women with either SpA or no IA. Non-steroidal anti-inflammatories (NSAIDs) and corticosteroid use was significantly higher in pregnant RA women compared to the other groups. RA women were significantly more likely to have an SGA baby (OR 1.51; 95% CI 1.21-1.88, p <0.01), and hypertensive disorder in pregnancy (OR 1.51; 95% CI 1.16-1.97, p<0.01), compared to no IA women while no difference was found between women with SpA and those with no IA.

CONCLUSION: 

Women with RA have a higher risk of worse maternal and neonatal outcomes whereas the risk of these events is similar between women with and without SpA.