Most pregnancies in the retrospective study occurred before rheumatoid arthritis (RA) symptoms appeared than occurred after disease onset. The 2% rate of pregnancy termination in the 86% of women who got pregnant before the onset of RA symptoms was significantly lower than a 6% termination rate among the 14% of women who got pregnant after developing RA, Dr. Cecilia Friden and her associates reported at the annual meeting of the American College of Rheumatology.
The investigators compared pregnancy histories in women enrolled in an RA registry in Boston with U.S. data on pregnant women of comparable ages (20–44 years), and compared outcomes between women who got pregnant before or after developing arthritis.
The cohort's history of 1,461 pregnancies included 1,146 live births, with birth defects in 2% of neonates. There was no association between the risk of birth defects and the timing of the onset of RA, said Dr. Friden of the Karolinska Institute, Stockholm. The study did not collect information on the use of disease-modifying antirheumatic drugs.
On the basis of nationwide data on pregnant women, the study found that the women with rheumatoid arthritis had slightly higher rates of miscarriage but slightly lower rates of stillbirths.
Pregnancy outcomes did not differ significantly between the pre- and post-RA pregnancy groups except for the termination rate. The rate of miscarriages, stillbirths, multiple births, low-birth-weight babies, and infants born before or after 32 weeks did not differ significantly between the two arthritis groups.
Dr. Friden reported no conflicts of interest. Her associates in the study have received research funds from pharmaceutical companies (some of which make arthritis medications) including Amgen Inc., Biogen Idec Inc., Bristol-Myers Squibb Co., Millennium Pharmaceuticals, and GlaxoSmithKline.
Several posters at the annual meeting of the American College of Rheumatology reported on pregnancy outcomes for women who had autoimmune diseases or were taking drugs for autoimmune diseases.
Lupus: A study of 198 women with clinically stable or mildly active systemic lupus erythematosus (SLE) at conception found severe flares were rare and good pregnancy outcomes were the rule, Dr. Jane E. Salmon of the Hospital for Special Surgery, New York, and her associates said.
Mild or moderate disease flares occurred in 6% within 20 weeks of gestation, in 5% at 32 weeks, and in 8% postpartum, according to data from the Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus (PROMISSE) study.
No severe flares occurred by 20 weeks. Severe flares were seen in less than 1% by 32 weeks and in 1.5% during the postpartum period in the ongoing prospective, multicenter study.
Pregnancy complications occurred in 15%, including fetal death (in 8%), neonatal death (3%), preeclampsia (15%), and fetal growth restriction (10%), with some women having more than one complication.
The investigators reported no conflicts of interest.
Adalimumab: The ongoing Autoimmune Diseases in Pregnancy Project run by the Organization of Teratology Information Specialists (OTIS) followed 33 women who took adalimumab for rheumatoid arthritis during the first trimester of pregnancy. Their birth outcomes were compared with birth outcomes of 52 pregnant women with the same disease but no adalimumab treatment and 45 pregnant women without rheumatoid arthritis. Preliminary data from the ongoing study suggest that rates of spontaneous abortion, stillbirth, congenital defects, and preterm deliveries are similar between groups and within the expected range in the general population, Dr. Johnson and her associates reported in a separate poster.
A larger sample size is needed, however, to draw firm conclusions, she added.
The companies that fund the OTIS Project include Abbott Laboratories, which markets adalimumab.
Systemic sclerosis: Worsening of systemic sclerosis and progression to organ problems in three of five Hungarian women after pregnancy were reported in a separate study.
The five pregnancies among 400 women with systemic sclerosis seen at two medical centers from 1995 to 2007 resulted in five infants with no severe organ complications, reported Dr. G. Szucs of the University of Debrecen (Hungary), and associates.
One mother with limited cutaneous disease had a normal, full-term delivery. One with diffuse cutaneous disease had a spontaneous preterm birth.
Three women (one with limited cutaneous disease and two with diffuse systemic sclerosis) delivered by C-section because of maternal hypertension and proteinuria with a high risk for renal crisis.
The hypertension and proteinuria disappeared after C-section delivery in one woman with diffuse disease, who was treated with an ACE inhibitor to avert renal crisis.
Three other women (one with limited disease and two with diffuse disease) developed fibrosing alveolitis, cardiomyopathy with arrhythmias or cardiac failure, renal failure, and/or rapidly progressing skin symptoms after delivery.