Rheumatoid Arthritis May Increase Risk for Adverse Pregnancy Outcomes

Major Finding: Mothers with rheumatoid arthritis were 1.47 times more likely than unaffected mothers to have a low-birth-weight baby, and 1.20 times more likely to have a baby deemed small for gestational age.

Data Source: From two large databases, researchers selected a sample of women who gave birth (1,912 with RA and 9560 controls).

Disclosures: The researchers made no disclosures.

Pregnant women with rheumatoid arthritis face an increased risk of adverse obstetric outcomes, and they deserve heightened prenatal attention, according to a recent report in the February issue of the Annals of Rheumatic Diseases.

Specifically, mothers with rheumatoid arthritis (RA) were 1.47 times more likely than unaffected mothers to have a low-birth-weight baby and 1.20 times more likely to have a baby deemed small for gestational age.

Women with RA also had a higher risk for developing preeclampsia (adjusted odds ratio, 2.22) or having to undergo a cesarian section (adjusted OR, 1.19), according to investigators from Taipei (Taiwan) Medical University (Ann. Rheum. Dis. 2010 Feb. [doi:10.1136/ard.2008.105262]).

“Our findings suggest a need for more intensive prenatal care among pregnant women with RA. In addition, early intervention should be considered to counter potential adverse obstetric outcomes for pregnant women with RA,” according to Herng Ching Lin, Ph.D., and associates, all of whom are with the university's school of health care administration.

Investigators used two databases in their analysis. The first was the Taiwan National Health Insurance Research Dataset (NHIRD), which included inpatient and ambulatory care claims from 1996 to 2003, and the second was the 2001-2003 National Birth Certificate Registry (NBCR), which is maintained by the government of Taiwan.

From the nearly 500,000 women who had live singleton births in Taiwan between 2001 and 2003, the investigators identified 1,912 mothers with RA (ICD-9-CM, code 714.0) and compared their pregnancy outcomes with those of 9,560 controls who were matched to the cases by age, parity, and year of delivery. The diagnosis of RA in the cases was usually made by a rheumatologist and based on clinical symptoms, radiographic changes, and the presence of rheumatoid factor.

Women with chronic diseases such as hypertension or diabetes that could increase the risk of adverse pregnancy outcomes were excluded.

The two groups of women did not differ significantly in their sociodemographic variables such as marital status, level of education, and household income.

The women with RA were no more likely than their unaffected peers to have preterm births. For women with RA, the mean gestational age was 38.4 weeks (range, 27-43); the mean gestational ages for mothers with and without RA were 38.3 weeks (range, 27-43) and 38.5 weeks (range, 29-41), respectively.

According to the authors, one strength of the study was its homogenous population: More than 98% of Taiwan's residents are of Chinese Han ethnicity.

Although this may have minimized the possibility that race affected the results, it may have also limited whether the results can be generalized to other ethnic groups.

Another strength is its large sample size.

One important limitation of the study was that the NHIRD did not include complete information about RA medications that were taken during pregnancy, a potentially important confounding factor.

A second limitation was that study participants were not differentiated according to RA severity.

Major Finding: Mothers with rheumatoid arthritis were 1.47 times more likely than unaffected mothers to have a low-birth-weight baby, and 1.20 times more likely to have a baby deemed small for gestational age.

Data Source: From two large databases, researchers selected a sample of women who gave birth (1,912 with RA and 9560 controls).

Disclosures: The researchers made no disclosures.

Pregnant women with rheumatoid arthritis face an increased risk of adverse obstetric outcomes, and they deserve heightened prenatal attention, according to a recent report in the February issue of the Annals of Rheumatic Diseases.

Specifically, mothers with rheumatoid arthritis (RA) were 1.47 times more likely than unaffected mothers to have a low-birth-weight baby and 1.20 times more likely to have a baby deemed small for gestational age.

Women with RA also had a higher risk for developing preeclampsia (adjusted odds ratio, 2.22) or having to undergo a cesarian section (adjusted OR, 1.19), according to investigators from Taipei (Taiwan) Medical University (Ann. Rheum. Dis. 2010 Feb. [doi:10.1136/ard.2008.105262]).

“Our findings suggest a need for more intensive prenatal care among pregnant women with RA. In addition, early intervention should be considered to counter potential adverse obstetric outcomes for pregnant women with RA,” according to Herng Ching Lin, Ph.D., and associates, all of whom are with the university's school of health care administration.

Investigators used two databases in their analysis. The first was the Taiwan National Health Insurance Research Dataset (NHIRD), which included inpatient and ambulatory care claims from 1996 to 2003, and the second was the 2001-2003 National Birth Certificate Registry (NBCR), which is maintained by the government of Taiwan.

From the nearly 500,000 women who had live singleton births in Taiwan between 2001 and 2003, the investigators identified 1,912 mothers with RA (ICD-9-CM, code 714.0) and compared their pregnancy outcomes with those of 9,560 controls who were matched to the cases by age, parity, and year of delivery. The diagnosis of RA in the cases was usually made by a rheumatologist and based on clinical symptoms, radiographic changes, and the presence of rheumatoid factor.

Women with chronic diseases such as hypertension or diabetes that could increase the risk of adverse pregnancy outcomes were excluded.

The two groups of women did not differ significantly in their sociodemographic variables such as marital status, level of education, and household income.

The women with RA were no more likely than their unaffected peers to have preterm births. For women with RA, the mean gestational age was 38.4 weeks (range, 27-43); the mean gestational ages for mothers with and without RA were 38.3 weeks (range, 27-43) and 38.5 weeks (range, 29-41), respectively.

According to the authors, one strength of the study was its homogenous population: More than 98% of Taiwan's residents are of Chinese Han ethnicity.

Although this may have minimized the possibility that race affected the results, it may have also limited whether the results can be generalized to other ethnic groups.

Another strength is its large sample size.

One important limitation of the study was that the NHIRD did not include complete information about RA medications that were taken during pregnancy, a potentially important confounding factor.

A second limitation was that study participants were not differentiated according to RA severity.

Major Finding: Mothers with rheumatoid arthritis were 1.47 times more likely than unaffected mothers to have a low-birth-weight baby, and 1.20 times more likely to have a baby deemed small for gestational age.

Data Source: From two large databases, researchers selected a sample of women who gave birth (1,912 with RA and 9560 controls).

Disclosures: The researchers made no disclosures.

Pregnant women with rheumatoid arthritis face an increased risk of adverse obstetric outcomes, and they deserve heightened prenatal attention, according to a recent report in the February issue of the Annals of Rheumatic Diseases.

Specifically, mothers with rheumatoid arthritis (RA) were 1.47 times more likely than unaffected mothers to have a low-birth-weight baby and 1.20 times more likely to have a baby deemed small for gestational age.

Women with RA also had a higher risk for developing preeclampsia (adjusted odds ratio, 2.22) or having to undergo a cesarian section (adjusted OR, 1.19), according to investigators from Taipei (Taiwan) Medical University (Ann. Rheum. Dis. 2010 Feb. [doi:10.1136/ard.2008.105262]).

“Our findings suggest a need for more intensive prenatal care among pregnant women with RA. In addition, early intervention should be considered to counter potential adverse obstetric outcomes for pregnant women with RA,” according to Herng Ching Lin, Ph.D., and associates, all of whom are with the university's school of health care administration.

Investigators used two databases in their analysis. The first was the Taiwan National Health Insurance Research Dataset (NHIRD), which included inpatient and ambulatory care claims from 1996 to 2003, and the second was the 2001-2003 National Birth Certificate Registry (NBCR), which is maintained by the government of Taiwan.

From the nearly 500,000 women who had live singleton births in Taiwan between 2001 and 2003, the investigators identified 1,912 mothers with RA (ICD-9-CM, code 714.0) and compared their pregnancy outcomes with those of 9,560 controls who were matched to the cases by age, parity, and year of delivery. The diagnosis of RA in the cases was usually made by a rheumatologist and based on clinical symptoms, radiographic changes, and the presence of rheumatoid factor.

Women with chronic diseases such as hypertension or diabetes that could increase the risk of adverse pregnancy outcomes were excluded.

The two groups of women did not differ significantly in their sociodemographic variables such as marital status, level of education, and household income.

The women with RA were no more likely than their unaffected peers to have preterm births. For women with RA, the mean gestational age was 38.4 weeks (range, 27-43); the mean gestational ages for mothers with and without RA were 38.3 weeks (range, 27-43) and 38.5 weeks (range, 29-41), respectively.

According to the authors, one strength of the study was its homogenous population: More than 98% of Taiwan's residents are of Chinese Han ethnicity.

Although this may have minimized the possibility that race affected the results, it may have also limited whether the results can be generalized to other ethnic groups.

Another strength is its large sample size.

One important limitation of the study was that the NHIRD did not include complete information about RA medications that were taken during pregnancy, a potentially important confounding factor.

A second limitation was that study participants were not differentiated according to RA severity.