Pregnant women with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) have an increased risk for preterm delivery, which may be partly attributed to disease activity and corticosteroid use, according to results published in Arthritis Care & Research.

The study included women enrolled before 19 weeks of gestation from the Organization of Teratology Information Specialists Autoimmune Disease in Pregnancy Project. The researchers collected patient-reported data on pregnancy events, medications, disease activity, and outcomes, which were validated by medical records.

Overall, 657 women with RA, 170 with JIA, and 564 healthy controls who delivered live-born infants from 2004 to 2017 were included.


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Compared with controls, participants with RA had an increased risk for preterm delivery (risk ratio [RR], 2.09; 95% CI, 1.50-2.91). Participants with JIA also had an increased risk for preterm delivery compared with controls (RR, 1.81; 95% CI, 1.14-2.89).

The researchers found that active RA at enrollment (adjusted RR, 1.58; 95% CI, 1.10-2.27) and any time during pregnancy (adjusted RR, 1.52; 95% CI, 1.06-2.18) were associated with preterm delivery.

Independent of disease activity, the results also indicated that corticosteroid use in every trimester was associated with an approximate 2- to 5-fold increased risk for preterm delivery.

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The researchers did not find any independent associations between preterm delivery and disease-modifying antirheumatic drugs or biologic medications.

“Further analyses are necessary to look at other categories of arthritis affecting women of childbearing age, racial disparities in these populations, as well as the influence of disease activity in the later stages of pregnancy on other perinatal factors that may contribute to [preterm delivery] risk,” the researchers wrote.

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Reference

Smith CJF, Förger F, Bandoli G, Chambers CD. Factors associated with preterm delivery among women with rheumatoid arthritis and juvenile idiopathic arthritis [published online August 21, 2018]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23730