Preterm delivery in patients with rheumatoid or idiopathic arthritis: what are the risks?

This study investigated the causes of preterm delivery (PTD) in women with inflammatory arthritis (IA).

They found that corticosteroids and disease activity were among the factors that increased the risk of PTD in women with IA.

Rheumatoid (RA) and juvenile idiopathic arthritis (JIA) are types of IA. Treatment options for patients with IA include non-steroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDs), biologics and corticosteroids. 

Women with inflammatory arthritis (IA) have a greater risk of preterm delivery (PTD; going into labor before the due date). The cause of PTD is unknown. Disease activity and medication may have an effect. However, it is unclear from previous studies if this is the case.

This study included 1391 pregnant women. 657 women had RA, 170 had JIA and 564 did not have any IA. Women were enrolled in the study before reaching the 19^th week of pregnancy. Disease activity (PAS score), medication and pregnancy outcomes were measured.

Mothers with RA and JIA had a greater risk of PTD and caesarian section. Women with RA had a higher risk of gestational diabetes (GD; diabetes that develops during pregnancy). They were also more likely to have an early delivery (before 32 weeks). Women with JIA had a higher risk of preeclampsia (PEE; dangerously high blood pressure during pregnancy). Women with RA with a high disease activity were 50% more likely to have a PTD.

Corticosteroid medication use during pregnancy increased the risk of PTD in women with RA and JIA. The use of NSAIDs in the first trimester was associated with a 2.31 times higher risk of PTD in women with JIA. Fever during pregnancy increased the risk of PTD in women with JIA. PEE and GD increased the risk of PTD in women with RA. DMARDs and biologics were not associated with PTD in women with RA and JIA.

The authors concluded that NSAIDs in the first trimester and corticosteroid treatment increased the risk of PTD. A higher disease activity and pregnancy complications like preeclampsia and gestational diabetes were risk factors for PTD in women with RA and JIA.

This study included a relatively small number of patients with JIA. Further investigation is needed to determine if certain medications affect PTD risk.

If you have any concerns about pregnancy and arthritis, please consult with your physician.