NEW YORK (Reuters Health) Dec 04 - Women with well controlled rheumatoid arthritis (RA) have pregnancy outcomes comparable to those in the general population, Dutch researchers report in the November issue of Arthritis and Rheumatism.
Women with poorly controlled disease have an increased risk of lower birth weight, however.
"The outcome of pregnancy...might be negatively influenced by RA, since unfavorable pregnancy outcome has been demonstrated in several rheumatic diseases," Dr. Yael A. de Man, of Erasmus MC, University Medical Center Rotterdam, the Netherlands, and colleagues write. "However, only a few studies have examined pregnancy outcomes in women with RA."
Dr. de Man and her colleagues prospectively studied pregnancy outcomes in women with RA in relation to disease activity and medication use during the pregnancy. The women were evaluated before pregnancy (if possible), during each trimester, and at 6, 12 and 26 weeks after delivery. The investigators analyzed clinical characteristics, disease activity, medication use, and pregnancy outcome.
A total of 152 white women with RA with singleton pregnancies participated. Disease activity was well controlled, with the median disease activity score decreasing from 3.8 during the first trimester to 3.3 during the third trimester. Mean daily doses of prednisone during pregnancy were 7.7 mg, 8.0 mg, and 7.7 mg during the first, second, and third trimesters, respectively.
Mean birth weight and mean birth weight standard deviation score were both comparable with that in the general population, the authors report. Multivariate analyses showed that only higher disease activity during the third trimester was significantly associated with lower birth weight (p = 0.025).
Multiple linear regression analyses of prednisone use during pregnancy showed a significant association with shorter gestational age (p < 0.001). Women taking prednisone had offspring with a significantly lower gestational age at delivery than those not taking prednisone (38.8 weeks versus 39.9 weeks, respectively). In addition, women taking prednisone more often delivered before 37 weeks (p = 0.004).
RA patients had a higher rate of instrumental vaginal delivery compared to the general population, whereas their rate of cesarean section was comparable to that in the general population. However, cesarean sections were performed significantly more often in women with higher levels of disease activity.
"For the obstetrician, our findings might imply that he or she should be aware of a higher incidence of cesarean section in RA patients with high levels of disease activity, as well as an increased risk of preterm delivery in RA patients taking prednisone," the researchers said.
They continued, "For the rheumatologist, our findings might indicate that he or she should strive for low levels of disease activity, both before and during pregnancy, for a better pregnancy outcome for their RA patients."
Arthritis Rheum 2009;60:3196-3206.
moderate disease before, and during my pregnancies..... 8lb 2 oz was my smallest... 9.15 my biggest.. all via cesarean section.... I am always oppositional to the findings.. odd woman out.