Background/Purpose:

Women who had JIA in childhood and adolescence may be at higher risk for adverse neonatal and maternal outcomes. Our objective was to examine aspects of prenatal care in women who had JIA versus those who did not have JIA, and to evaluate the association between prenatal care and risk of adverse outcomes.

Methods:

We designed a cohort study using data from physician billing and hospitalization data covering Québec, Canada. The cohort contained all females with JIA with a first-time birth between 01/01/1983 and 12/31/2010 (n=1681) and a control cohort of first-time mothers without JIA from the same administrative data, matching 4:1 for date of first birth, age of mother and area of residence (n=6724). Using the revised G-INDEX (which is based on the American College of Obstetricians and Gynecologists recommendations for prenatal visits for low risk pregnant women), we determined prenatal care as adequate, intermediate, inadequate, and a group with no care or missing data. This latter group may contain those mothers that receive no prenatal care or those that see salaried physicians, midwives or nurses whose services are not recorded in the physician billing data. We described and compared prenatal care in mothers with JIA and those who did not have JIA and used logistic regression analysis to determine the association between prenatal care levels and adverse outcomes (prematurity, small for gestational age, and major congenital malformations) adjusted for maternal age, education and socioeconomic status (deprivation index).

Results:

In our entire cohort 1.4% of mothers in the JIA group and 4.6% in the non JIA group were classified as receiving inadequate care.  Adequate, and intermediate care were 32.9 and 8.4% respectively in the JIA group and 57.7 and 21.9% in the non-JIA group. Nearly a quarter of our cohort (24.1%) had missing data or received no prenatal care, and this was substantially higher in the JIA group (57.4% vs 15.8% in the non-JIA group). We were unable to detect an increased risk of an adverse event in the JIA or non-JIA group when comparing adequate/intermediate care to inadequate prenatal care .  However, being in the no care/ missing group was associated with having a child with a major congenital malformation in both the JIA group (adjusted Relative Risk (RR), 1.95; 95% Confidence Interval (CI) 1.37,2.79) and non-JIA groups (adjusted RR 1.81; 95% CI 1.14,2.87). 

Conclusion:

Mothers with a history of JIA differ from those without JIA in terms of prenatal care patterns. In both groups, having no record of prenatal care was associated with having an adverse birth outcome.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-comparison-of-prenatal-care-in-mothers-with-and-without-jia-association-with-outcomes/