To evaluate pregnancy outcomes in patients with rheumatoid arthritis (RA) compared to the general population.
Approach:
Study Design: A prospective multicenter study analyzing 100 pregnancies among 90 RA patients, comparing outcomes with 359 pregnancies from the French general population.
Data Collection: Maternal characteristics, disease activity, treatment exposure, obstetric history, and pregnancy outcomes were prospectively collected.
Statistical Analysis: Univariate analyses and multilevel mixed-effects logistic regression were used to evaluate outcomes and identify factors associated with preterm birth and small-for-gestational-age infants.
Key Findings:
Preterm birth occurred in 16% of RA pregnancies vs 8% of matched controls.
Small-for-gestational-age birth below the 10th percentile occurred in 21% of RA pregnancies vs 11% of controls.
Nulliparity was associated with small-for-gestational-age birth.
Maternal age and glucocorticoid exposure at doses of at least 10 mg/day were independently associated with preterm birth.
Interpretation:
Patients with RA had about twice the odds of experiencing preterm birth and small-for-gestational-age births compared to the general population.
Limitations:
Relatively small sample size.
Potential selection bias toward more complex or severe cases.
Incomplete disease-activity data.
Potential disease-activity misclassification.
Residual confounding.
Conclusion:
The study highlights increased risks of adverse birth outcomes in pregnancies among patients with RA.
