Physical Domains of Postpartum Parenting Difficult in Mothers With Rheumatoid Arthritis

Mother and child, infant, postpartum
Mother and child, infant, postpartum
Mothers with rheumatoid arthritis frequently report high postpartum parenting disability.

Physical domains of postpartum parenting, including carrying and playing with children and completing household chores, are most commonly affected in mothers with rheumatoid arthritis (RA), according to study results published in Rheumatic & Musculoskeletal Diseases.

Participants were enrolled in this study from the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA) cohort, with data collected at visits before pregnancy, each trimester, and 3 times postpartum (6, 12, and 26 weeks). Participants completed questionnaires, including the Parenting Disability Index (PDI) and the Health Assessment Questionnaire (HAQ), at all visits. The PDI contained 25 questions to quantify parenting disability in mothers with arthritis, and used a 5-point response scale. The PDI included an additional section where participants could indicate whether the parenting task was performed less because of reasons related to arthritis.

To identify patients at risk for parenting disabilities postpartum, univariate logistic regression models were used for the analyses of patient characteristics associated with low and high parenting disability. Patient characteristics obtained in the first trimester of pregnancy included age, disease duration, previous childbirth, socioeconomic status, erosive disease, disease activity, and HAQ score.

A total of 148 patients with RA were included in the study; 149 children were born from these participants. Overall, 50.7% of patients already had children, 71.6% were rheumatoid factor positive, and 62.2% were anticitrullinated protein antibody positive; the mean duration of RA was 6.4 years.

According to findings from the PDI, the domains in which respondents had the most difficulty were picking up or carrying their child, doing household chores or shopping, taking their child out of the car, getting up and down from the floor to play with their child, taking care of their child’s hygiene, feeding their child, and using a car seat. Respondents reported least difficulty in domains including taking care of their child when they were sick, maintaining discipline with their child, having other children in their home, and having the energy to listen and talk with their child.

A total of 78.5%, 86.2%, and 86.1% of patients reported any parenting problems at 6, 12, and 26 weeks postpartum, respectively. At the 12-week visit, low, medium, and high parenting disability were observed in 37 (30.1%), 38 (30.9%), and 48 (39.0%) of patients, respectively.

Results of the univariate and multivariate logistic regression analyses indicated that patients with a low HAQ score (≤0.625) and low disease activity (disease activity score 28-joint count C-reactive protein, <3.2) in the first trimester of pregnancy were likely to report low parenting disability (P <.001 and P =.002, respectively). Reporting a high HAQ score in the first trimester of pregnancy greatly increased the odds of reporting high parenting disability postpartum (odds ratio, 4.54; 95% CI, 1.99-10.34; P <.001). The presence of erosive disease had a slight significant association with reporting high parenting disability.

Study limitations included the fact that the analyses did not reflect the current patient population, as the PARA study was completed over a decade ago; differences in medication use and disease activity of patients; and the lack of a control group of healthy mothers.  

“With the identification of the parenting domains that cause the most difficulties for patients and which patients are at risk for developing parenting disability, targeted interventions and education can be designed,” concluded the researchers.


Smeele HTW, de Man Y, Röder E, Wintjes H, Hazes JMW, Dolhain RJEM. Parenting problems postpartum can be detected early in pregnancy in patients with rheumatoid arthritis. RMD Open. 2020;6(2):e001276.