Study Finds 2 Factors Associated With Adverse Outcomes Among Pregnant Women With RA

Antinuclear antibody (ANA) positivity and history of miscarriage are both independent risk factors for adverse pregnancy outcomes (APOs) among women with rheumatoid arthritis (RA), according to a study published in Clinical Rheumatology.

The study also found that APOs and low-dose prednisone have no effect on the health of the child, though there is no clear consensus on this relationship.

To come to these findings, the study authors included 67 pregnant women with RA who were hospitalized between January 2007 and September 2021 in the Department of Obstetrics at Peking University People’s Hospital in China.

Women with RA are at higher risk of experiencing APOs, such as preterm delivery, low birth weight, small for gestational age infants, or preeclampsia, compared with pregnant women without RA, the authors explained. Additionally, high RA disease activity and the use of prednisone during pregnancy are both associated with increased APO risk in this group.

The participants were seen at least once per trimester and after delivery to evaluate any associations between RA disease activity, medication use, and pregnancy outcomes. Data on RA disease activity and fetal outcomes were collected from medical records.

Of the 67 women in the cohort, 29 (43.3%) experienced an APO, with the most common pregnancy complications being postpartum hemorrhage (20.9%) and premature delivery (11.9%).

The 2 risk factors for APOs identified in the study were previous miscarriages (OR, 1.869; 95% CI, 1.053-3.318, P = .033) and ANA positivity (OR, 3.168; 95% CI, 1.068-9.768, P = .045).

The RA disease activity remission rate during pregnancy was higher in women without APOs compared with women who did experience APOs (P = .027), however there were no significant differences between these 2 groups regarding daily and cumulative prednisone doses (P > .05).

According to the authors, the reason for disease remission during pregnancy is still unclear, even when accounting for hormonal changes and immunological alterations during pregnancy. They also noted that some studies found a link between remission and galactosylation.

“In the context of inflammatory joint disease, there is no significant improvement in disease activity during pregnancy, as 43.3% of patients showed worsening of arthritis during pregnancy in our study, and more than half of RA patients showed worsening of arthritis after delivery in another study,” the authors write.

The study also included a total of 71 fetuses of these women. Of this group, 2 fetuses were aborted, 2 were delivered by induced labor due to chromosomal abnormality, and 1 died in utero. The children of the participants were followed up with, and long-term follow-up showed no significant differences in the children’s health between women who did and did not experience APOs (P > .05).

According to the authors, these findings suggest ANA is a potential biomarker for predicting APOs in women with RA, further suggesting all patients with RA should be screened for ANA beforehand if they wish to become pregnant.

The authors noted that the small sample size is a major limitation of the study, especially due to the fact that RA onset is typically past the childbearing age.

Reference

Luo L, Li X, Yan R, Zhang H, Li C. Risk factors for adverse pregnancy outcomes in women with rheumatoid arthritis and follow-up of their offspring. Clin Rheumatol. Published online June 13, 2022. doi:10.1007/s10067-022-06233-9