Pregnancy outcomes of patients with rheumatoid arthritis

Year 2020, Volume: 45 Issue: 2, 518 - 525, 30.06.2020

Erdem Fadıloğlu , Canan Unal , Atakan Tanacan , M.sinan Beksac

https://doi.org/10.17826/cumj.664235

Abstract

Purpose: The aim of this studywas to evaluate the obstetric outcomes of women with rheumatoid arthritis (RA)
Materials and Methods: This retrospective study consisted of 39 women with RA. Patients were evaluated in terms of seropositivity, having disease >5 years or not and use of any medication.
Results: Rate of preterm delivery and intrauterine growth retardation was 33.3% and 21.2%, respectively. Comparisons between seropositive and seronegative women did not show any significant difference. Having disease more or less than 5 years did not show any significant difference in terms of obstetric outcomes. Women with a coexisting disease had a similar rate of miscarriage rate compared to remainders (16.6% vs 14.8%). Women followed up without any medication has also higher rates of miscarriage despite lack of statistical significance.
Conclusion: Pregnancies of women with RA must be considered as high risk due to increased rates of adverse pregnancy outcomes such as preterm delivery and intrauterine growth retardation. 

Keywords

Pregnancy, rheumatoid arthritis, obstetric outcome, miscarriage, preterm delivery, intrauterine growth retardation, seropositivity

Romatoid artrit hastalarının gebelik sonuçları

Abstract

Amaç: Bu çalışmanın amacı romatoid Artrit (RA) hastalarının gebelik sonuçlarını değerlendirmektir.
Gereç ve Yöntem: Retrospektif planlanan çalışmamız 39 hastadan oluşmaktadır. Hastalar seropozitivite, hastalık süresinin 5 yıldan uzun olması ve ilaç kullanımı açısından değerlendirildiler.
Bulgular: Preterm doğum ve intrauterin gelişme geriliği oranı sırasıyla 33.3% ve 21.2% olarak bulundu. Seropozitif ve seronegatif hastalara ilişkin yapılan karşılaştırmalarda anlamlı fark izlenmedi. Hastalığın 5 yıldan uzun süredir olması ya da olmamasının da gebelik sonuçlarına etki etmediği görüldü. Ek bir hastalığı olanlarda ise diğer hastalarda benzer oranda düşük izlendi (%16.6, %14.8). İlaçsız olarak izlenen hastalarda ise istatistiksel farklılık olmamasına rağmen daha yüksek oranda düşük izlendi.
Sonuç: RA tanısı olan gebeliklerin preterm doğum ya da intrauterin gelişme geriliği gibi komplikasyonların daha sık izlenmesi nedeniyle yüksek riskli gebelikler olarak değerlendirilmesi gerekmektedir.

Keywords

romatoid artrit, gebelik, obstetrik sonuç, düşük, preterm doğum, intrauterin gelişme geriliği, seropozitivite

References

• 1. Tanacan A, Unal C, Yucesoy HM, Duru SA, Beksac MS. Management and evaluation of pregnant women with Takayasu arteritis. Archives of gynecology and obstetrics. 2019;299(1):79-88. 2. Tanacan E, Tanacan A, Fadiloglu E, Unal C, Beksac MS. Psoriasis and Pregnancy: Retrospective Evaluation of 47 Pregnancies in a Tertiary Center. Gynecology Obstetrics & Reproductive Medicine. 2018:1-5. 3. Hunter TM, Boytsov NN, Zhang X, et al. Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004-2014. Rheumatology international. 2017;37(9):1551-7. 4. Brouwer J, Fleurbaaij R, Hazes JMW, Dolhain R, Laven JSE. Subfertility in Women With Rheumatoid Arthritis and the Outcome of Fertility Assessments. Arthritis care & research. 2017;69(8):1142-9. 5. Gotestam Skorpen C, Lydersen S, Gilboe IM, et al. Women with systemic lupus erythematosus get pregnant more easily than women with rheumatoid arthritis. Rheumatology (Oxford, England). 2018;57(6):1072-9. 6. Rom AL, Wu CS, Olsen J, et al. Fetal growth and preterm birth in children exposed to maternal or paternal rheumatoid arthritis: a nationwide cohort study. Arthritis & rheumatology (Hoboken, NJ). 2014;66(12):3265-73. 7. Nelson JL, Østensen M. Pregnancy and rheumatoid arthritis. Rheumatic disease clinics of North America. 1997;23(1):195-212. 8. de Jong PH, Dolhain RJ. Fertility, Pregnancy, and Lactation in Rheumatoid Arthritis. Rheumatic diseases clinics of North America. 2017;43(2):227-37. 9. Temprano KK, Bandlamudi R, Moore TL. Antirheumatic drugs in pregnancy and lactation. Seminars in arthritis and rheumatism. 2005;35(2):112-21. 10. de Man YA, Dolhain RJ, van de Geijn FE, Willemsen SP, Hazes JM. Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study. Arthritis and rheumatism. 2008;59(9):1241-8. 11. De Man YA, Dolhain RJ, Van De Geijn FE, Willemsen SP, Hazes JM. Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study. Arthritis Care & Research: Official Journal of the American College of Rheumatology. 2008;59(9):1241-8. 12. van den Brandt S, Zbinden A, Baeten D, et al. Risk factors for flare and treatment of disease flares during pregnancy in rheumatoid arthritis and axial spondyloarthritis patients. Arthritis research & therapy. 2017;19(1):64. 13. Teitsson I, Withrington R, Seifert M, Valdimarsson H. Prospective study of early rheumatoid arthritis. I. Prognostic value of IgA rheumatoid factor. Annals of the rheumatic diseases. 1984;43(5):673. 14. Nishimura K, Sugiyama D, Kogata Y, et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Annals of internal medicine. 2007;146(11):797-808. 15. Unterscheider J, Daly S, Geary MP, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. American journal of obstetrics and gynecology. 2013;208(4):290.e1-6. 16. Mumusoglu S, Beksac MS, Ekiz A, Ozdemir P, Hascelik G. Does the presence of autoantibodies without autoimmune diseases and hereditary thrombophilia have an effect on recurrent pregnancy loss? The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2016;29(14):2352-7. 17. Beksaç K, Örgül G, Çağan M, et al. Retrospective evaluation of pregnant women with celiac disease. Journal of the Turkish German Gynecological Association. 2017;18(1):56. 18. Beksac K, Orgul G, Can GS, et al. Management of Inflammatory Bowel Disease and Pregnancy using Prophylactic Low Dose Low Molecular Weight Heparin and Corticosteroids. Journal of Clinical & Diagnostic Research. 2017;11(11). 19. Turgal M, Gumruk F, Karaagaoglu E, Beksac MS. Methylenetetrahydrofolate reductase polymorphisms and pregnancy outcome. Geburtshilfe und Frauenheilkunde. 2018;78(09):871-8. 20. Norgard BM, Larsen MD, Friedman S, Knudsen T, Fedder J. Decreased chance of a live born child in women with rheumatoid arthritis after assisted reproduction treatment: a nationwide cohort study. Ann Rheum Dis. 2019. 21. Örgul G, Soyak B, Aydın E, et al. 22 Haftayı Geçemeyen Gebelikler. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2017;14(2). 22. Brouwer J, Laven JS, Hazes JM, Dolhain RJ. Brief Report: Miscarriages in Female Rheumatoid Arthritis Patients: Associations With Serologic Findings, Disease Activity, and Antirheumatic Drug Treatment. Arthritis & rheumatology (Hoboken, NJ). 2015;67(7):1738-43. 23. Langen ES, Chakravarty EF, Liaquat M, El-Sayed YY, Druzin ML. High rate of preterm birth in pregnancies complicated by rheumatoid arthritis. American journal of perinatology. 2014;31(1):9-14. 24. Davutoglu EA, Ozel A, Yilmaz N, Madazli R. Pregnancy outcome in 162 women with rheumatic diseases: experience of a university hospital in Turkey. Arch Gynecol Obstet. 2017;296(6):1079-84. 25. de Man YA, Bakker-Jonges LE, Goorbergh CM, et al. Women with rheumatoid arthritis negative for anti-cyclic citrullinated peptide and rheumatoid factor are more likely to improve during pregnancy, whereas in autoantibody-positive women autoantibody levels are not influenced by pregnancy. Ann Rheum Dis. 2010;69(2):420-3. 26. Bujold E, Roberge S, Lacasse Y, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstetrics and gynecology. 2010;116(2 Pt 1):402-14. 27. Forger F, Villiger PM. Treatment of rheumatoid arthritis during pregnancy: present and future. Expert review of clinical immunology. 2016;12(9):937-44.