Juvenile Idiopathic Arthritis Increases Risk of Postpartum Complications

Ongoing inflammation related to JIA may put first-time mothers at risk for complications.

First-time mothers with juvenile idiopathic arthritis (JIA) are more likely to be at risk for complications from anesthesia, postpartum hemorrhage, and thromboembolism than healthy controls, according to research recently published in the journal Rheumatology.

“Risks for these outcomes were higher for women who had visited their rheumatologist in the 12 months before giving birth,” Debbie Ehrmann Feldman, PhD, of the Université de Montréal in Québec, Canada, and colleagues wrote.

Dr Feldman and colleagues analyzed administrative data from physician billing and hospitalizations related to first-time births from mothers with JIA between January 1983 and December 2010. The researchers matched the data from mothers with JIA (n=1681, mean age, 24.7) with a control group (n=6782, mean age, 25) for factors such as geographical region, age, and date of first birth. The primary outcomes were major puerperal infection, postpartum hemorrhage, thromboembolism, obstetrical trauma, obstetrical surgical complications, maternal depression, and anesthetic complications.

“Anesthetic complications in our study include pulmonary, cardiac, nervous system, and other complications related to administration of anesthetic or sedation in labor or delivery,” they wrote.

The researchers found the adjusted risk ratios (aRR) in the JIA group were 2.17 (95% CI, 1.05-4.48) for anesthetic complications, 2.75 (95% CI, 2.42-3.11) for postpartum hemorrhage, and 5.27 (95% CI, 1.83-15.17) for thromboembolism. However, patients in the JIA group were at a lower risk for obstetrical trauma (aRR 0.78; 95% CI, 0.64-0.95) and postpartum depression in the first year (aRR 0.52; 95% CI, 0.40-0.68) compared with the control group.

“Interestingly, we found that women with JIA are at considerably lower risk for developing postpartum depression,” Dr Feldman and colleagues wrote. “There may be under-reporting of this diagnosis in administrative databases; the prevalence in our cohort was 5.9%, whereas Canadian studies that used the Edinburgh Postnatal Depression Scale to assess postpartum depression indicate higher frequencies between 7.5 and 8.7%.”

“Our results may also imply that women with ongoing disease (defined in our study as those who saw a rheumatologist in the year before giving birth) may be at higher risk for anesthetic complications and postpartum hemorrhage,” they continued. “It is possible that ongoing inflammation might increase the risk for these outcomes.”

Study Limitations

The researchers noted that because the study was based on administrative diagnosis codes for inflammatory arthritis, misclassification of patients with JIA was possible.

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Feldman DE, Vinet E, Sylvestre M-P, et al. Postpartum complications in new mothers with juvenile idiopathic arthritis: a population-based cohort study [published online April 27, 2017]. Rheumatology.  doi:10.1093/rheumatology/kex168