High RA disease activity linked to preterm delivery, low birth weight


Bharti B, et al. J Rheumatol. 2015;doi:10.3899/jrheum.140583.

April 20, 2015

Pregnant women with high disease activity in early pregnancy were more likely to have a preterm delivery or a child who was small for gestational age, according to newly published study findings.

Patients were identified through the Organization of Teratology Information Specialists (OTIS), a North American university and hospital-based network of telephone-based teratogen counseling services across the United States and Canada, and its Autoimmune Diseases in Pregnancy Project, a prospective cohort study of pregnant women both with and without an autoimmune disease. Researchers included 440 pregnant women with rheumatoid arthritis (RA) who were interviewed prior to 20 weeks gestation and at 2 weeks to 4 weeks after delivery.
, which included the HAQ Disability Index (HAQ-DI), pain score (PS) and Patient’s Global Scale (PGS) to assess disease activity. Data were self-reported and verified through medical records at the rate of up to 95% reviewed.

Preterm delivery was defined as delivery before 37 weeks of gestation, and small for gestational age (SGA) was defied as birth weight at or below the 10th percentile.

The overall prevalence of preterm birth was 15%; SGA outcome was 9%, and 42% had cesarean deliveries. Patients who had preterm deliveries were more likely to be older, have another autoimmune disease, have used more than 10 mg of prednisone daily and have had a prior preterm delivery. Additionally, they were less likely to be non-Hispanic white.

Women who delivered a SGA infant were more likely to have Crohn’s disease, to have used more than 10 mg of prednisone daily and to be primiparous.

Cesarean delivery was more common in women who were older and overweight or obese.

Bivariate analysis showed that HAQ-DI and PGS were significantly associated with preterm delivery. The HAQ-DI correlated to both SGA and cesarean delivery, according to the researchers.

Multivariate analysis, including adjustments for prior preterm birth, maternal age, high dose of prednisone, education and gestational age using Poisson regression modeling, showed a 58% increase in the risk for preterm delivery was present with every one unit increase in the HAQ-DI score, and prednisone use over 10 mg was an independent predictor of increased risk. – by Shirley Pulawski

Disclosure: The researchers report no relevant financial disclosure


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