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Peripartum Outcomes in Women with RA or SpA
Women with rheumatoid arthritis (RA) have a higher risk of worse maternal and neonatal outcomes, a new study found, whereas the risk of these events is similar between women with and without spondyloarthritis (SpA). A contemporary pregnancy cohort of 312,081 women and corresponding birth events was assembled for the province of Alberta from the random selection of 1 live birth event per woman. 3 groups were identified: the no inflammatory arthritis (IA) group (no IA, n=308,989), the RA group (n=631), and the SpA group (n=2,461). Researchers compared maternal and neonatal outcomes, comorbid conditions and medication use between the 3 groups. They found:
- Pregnant women with RA were significantly more likely to have preterm deliveries, cesarean sections, hypertensive disorders in pregnancy, and small for gestation age (SGA) babies compared to pregnant women with either SpA or no IA.
- Nonsteroidal anti-inflammatory drug (NSAIDs) and corticosteroid use was significantly higher in pregnant women with RA compared to the other groups.
- Women with RA were significantly more likely to have an SGA baby and hypertensive disorder in pregnancy compare to no IA women while no difference was found between women the SpA and those with no IA.
Keeling S, Bowker S, Savu A, Kaul P. A population level analysis of the differing impacts of rheumatoid arthritis and spondyloarthritis on peripartum outcomes. [Published online ahead of print May 1, 2019]. J Rheumatol. doi: 10.3899/jrheum.181320.
The effects of RA and its treatment on pregnancy outcomes has been studied in detail, though less information is available on spondyloarthropathy (SpA) and pregnancy outcomes. This study examines maternal and neonatal outcomes in women with RA, SpA, and no inflammatory arthritis in Alberta, Canada. Women with RA had higher rates of pregnancy complications compared to women without arthritis and women with SpA, including pre-term delivery, gestational hypertension, and small for gestational age babies. Women with RA were, as expected, also more likely to take several different types of medications, including steroids, NSAIDs, and biologics and were more likely to have other comorbidities such as diabetes, hypertension, and cardiovascular disease. Medication use was low overall in the study population, as expected, though NSAID use is common among non-pregnant women with SpA. While these numbers are not surprising, it seems a little unusual that the number of women with RA in the study population was only 631 out of 312, 081 (0.2%), while the number of women with SpA was 2,461 (0.8%). The SpA group did combine both axial spondyloarthropathy and psoriatic arthritis patients, and women with psoriasis only were included in the psoriatic arthritis/SpA category. This affects our ability to interpret and extrapolate to other populations as the numbers of psoriasis, psoriatic arthritis, and ankylosing spondylitis patients were not reported. —Arundathi Jayatilleke, MD