Disease Activity Drives Adverse Pregnancy Outcomes in RA Save

Two large RA registries have shown that pregnancy outcomes in rheumatoid arthritis (RA) patients is more related to RA disease activity rather than treatments use to control RA. 

Analysis of the Swedish Rheumatology Quality Register abd the Danish clinical quality register (DANBIO) sought to link specific to pregnancy outcomes, especially preterm birth (PTB) and small for gestational age (SGA), to RA disease activity and anti-rheumatic treatment before and during pregnancy.

Overall 1739 RA-pregnancies were compared to 17 390 control-pregnancies (matched 1:10 on maternal age, birth year, parity) with delivery 2006–18.

RA pregnancies had an increased aOR of PTB [1.92 (1.56–2.35)] and SGA [1.93 (1.45–2.57)] vs controls.

This was further increased in those RA-pregnancies with DAS28-CRP ≥4.1 (vs <3.2) during pregnancy:

• PTB: aOR was 3.38 (1.52–7.55)
• SGA: aOR was 3.90 (1.46–10.4)

By comparison there was less of an effect on PTB with oral steroids during pregnancy (aOR 2.1; 0.94–4.74) or with biologics use (aOR1.38; 0.66–2.89). Combination therapy, including biologics before pregnancy, was a marker of increased risk of both PTB and SGA.

These data suggest that RA activity should be carefully monitored and aggressively treated during pregnancy, especially if they have moderate to high disease activity.