Factors associated with preterm delivery among women with rheumatoid arthritis and juvenile idiopathic arthritis.

Smith, Chelsey J F; Förger, Frauke; Bandoli, Gretchen; Chambers, Christina D (2019). Factors associated with preterm delivery among women with rheumatoid arthritis and juvenile idiopathic arthritis. Arthritis care & research, 71(8), pp. 1019-1027. Wiley 10.1002/acr.23730

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OBJECTIVE

Pregnant women with inflammatory arthritis may be at increased risk for preterm delivery (PTD), yet it is unclear what drives this risk. This prospective cohort study of pregnant women with rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), or healthier comparison women analyzed the independent effects of maternal disease activity, medication use, and comorbid pregnancy conditions on PTD risk.

METHODS

Women were enrolled before 19 weeks' completed gestation as part of the Organization of Teratology Information Specialists (OTIS) Autoimmune Disease in Pregnancy Project. Data on pregnancy events, medications, disease activity, and outcomes were obtained by maternal report and validated by medical records. Poisson regression with robust standard errors estimated risk ratios (RR), multivariable adjusted risk ratios (aRR) and 95% Confidence Intervals (CI).

RESULTS

A total of 657 women with RA, 170 with JIA, and 564 comparison women without autoimmune disease who delivered live-born infants from 2004-2017 were included for analysis. Both RA and JIA groups had an increased risk of PTD versus the comparison group (RR 2.09, 95% CI 1.50-2.91; and RR 1.81, 95% CI 1.14-2.89, respectively). Active RA at enrollment (aRR 1.58, 95% CI 1.10-2.27) and anytime during pregnancy (aRR 1.52, 95% CI 1.06-2.18) was associated with PTD. Corticosteroid use in every trimester was associated with an approximate 2 to 5-fold increased risk for PTD for both arthritis groups, independent of disease activity.

CONCLUSION

Women with RA and JIA are at increased risk for PTD. Maternal disease activity and corticosteroid use may contribute to some of this excess risk. This article is protected by copyright. All rights reserved.

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