Pregnancies in women with rheumatoid arthritis linked to Increased Adverse Outcomes

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Women of childbearing age with rheumatoid arthritis (RA) have increased risks of adverse pregnancy outcomes, as indicated by findings from an 11-year nationwide study in France published in Rheumatic & Musculoskeletal Diseases Open.  

 The study, conducted by Pina and colleagues, utilized the French National Health Data System to analyze pregnancies concluded between 2010 and 2020, encompassing 11,792 RA pregnancies and 10,413,681 non-RA pregnancies. The results revealed that 74.5% of RA pregnancies resulted in live births, with 0.4% ending in stillbirths. Notably, RA pregnancies demonstrated an elevated incidence of adverse outcomes, including preterm births (adjusted odds ratio [ORa] 1.84; 9), very preterm births (ORa 1.43), low birth weight (ORa 1.65), Cesarean section (ORa 1.46), and pregnancy-related hospitalization (ORa 1.30). These findings underscore the importance of comprehensive care strategies for pregnant women with RA, especially those with active disease before or during pregnancy, to mitigate adverse pregnancy outcomes. Interestingly, the disease activity decreased during pregnancy. However, active RA still exhibited elevated risks of prematurity (ORa 2.02; 95% CI 1.71 to 2.38), small for gestational age (ORa 1.53; 95% CI 1.28 to 1.83), and caesarean section (ORa 1.25; 95% CI 1.11 to 1.40) compared to non-active RA. 

 Pregnancy often coincides with a temporary alleviation of rheumatic activity in rheumatoid arthritis (RA), marked by reduced medication usage compared to pre-conception. A meta-analysis indicates that 60% of RA patients experience improved disease activity during pregnancy, with 47% encountering postpartum flares. Despite this, RA can impose adverse effects on pregnancy, leading to outcomes like prematurity, Cesarean sections, and low birth weight. 

 This population-based study underscores that, even in the era of targeted therapies, pregnancies in women with RA are associated with increased adverse outcomes compared to those without RA, especially when the disease is active during, and even before pregnancy. These findings emphasize the need for preconception counseling and meticulous pregnancy planning for women with RA, including monitoring disease activity throughout pregnancy. 

References 

  1. Pina Vegas L, Drouin J, Weill A, Dray-Spira R. Pregnancy outcomes in women with rheumatoid arthritis: an 11-year French nationwide study. RMD Open. 2024 Jan 19;10(1):e003762. 
  2. Jethwa H, Lam S, Smith C, Giles I. Does Rheumatoid Arthritis Really Improve During Pregnancy? A Systematic Review and Metaanalysis. The Journal of Rheumatology. 2019 Mar 1;46(3):245–50. 
  3. Keeling SO, Bowker SL, Savu A, Kaul P. A Population-level Analysis of the Differing Effects of Rheumatoid Arthritis and Spondyloarthritis on Peripartum Outcomes. The Journal of Rheumatology. 2020 Feb 1;47(2):197–203.