PT  - JOURNAL ARTICLE
AU  - Stephanie Keeling
AU  - Samantha Bowker
AU  - Anamaria Savu
AU  - Padma Kaul
TI  - A Population Level Analysis of the Differing Impacts of Rheumatoid Arthritis and Spondyloarthritis on Peripartum Outcomes
AID  - 10.3899/jrheum.181320
DP  - 2019 May 01
TA  - The Journal of Rheumatology
PG  - jrheum.181320
4099  - http://www.jrheum.org/content/early/2019/04/24/jrheum.181320.short
4100  - http://www.jrheum.org/content/early/2019/04/24/jrheum.181320.full
AB  - Objective The impact of rheumatoid arthritis (RA) and spondyloarthritis (SpA) on maternal and neonatal outcomes at a population level has not previously been well compared. Methods A contemporary pregnancy cohort of 312,081 women and corresponding birth events was assembled for the province of Alberta from the random selection of one live birth event per woman. We identified three groups: (1) no inflammatory arthritis (no IA, N=308,989), (2) RA (N=631), and (3) SpA (N=2,461). We compared maternal and neonatal outcomes, co-morbid conditions and medication use between the three groups. Multivariable logistic regression models evaluated the independent association between RA and SpA, relative to no IA, and the outcomes of small for gestation age (SGA) and hypertensive disorders during pregnancy. Results Pregnant women with RA were significantly more likely to have pre-term deliveries (13.5%), caesarean sections (33.9%), hypertensive disorders in pregnancy (10.5%) and SGA babies (15.6%), compared to pregnant women with either SpA or no IA. Non-steroidal anti-inflammatories (NSAIDs) and corticosteroid use was significantly higher in pregnant RA women compared to the other groups. RA women were significantly more likely to have an SGA baby (OR 1.51; 95% CI 1.21-1.88, p <0.01), and hypertensive disorder in pregnancy (OR 1.51; 95% CI 1.16-1.97, p<0.01), compared to no IA women while no difference was found between women with SpA and those with no IA. Conclusion Women with RA have a higher risk of worse maternal and neonatal outcomes whereas the risk of these events is similar between women with and without SpA.