Background/Purpose: Actually better control of rheumatoid arthritis (RA) activity leads to new interrogations and daily questions about pregnancy. Only few studies have studied pregnancy outcomes in women with RA, and results have shown some discrepancies. The objective is to determine the effect of Rheumatoid Arthritis on pregnancy outcomes, specially hypertension and preeclampsia, low birth weight, preterm birth, perinatal mortality, congenital malformation and cesarean section in women with Rheumatoid Arthritis

Methods: A litterature search was performed from Medline and Cochrane databases for articles published in english from 1955 to May 2016. Studies were eligible if they presented prevalence study, including national birth registry. Population were women with Rheumatoid Arthritis and keys terms related to pregnancy outcomes. Meta-analysis were performed to assess odds-ratios (OR) for each studied group using the inverse variance approach to estimate pooled OR with their 95% confidence interval (95% IC). Heterogeneity was assessed according to Cochran’s Q-test and I2 values. Calculations were made with the Cochrane RevMan 5.3 software. P-values less than 0.05 were considered as significant.

Results: Expanded literature searche identified 1002 papers, of which 68 were eligible. Meta-analysis calculations showed a significant increased risk of prematurity with an OR of 1,42 (95% CI 1,29 to 1,56), low birth weight with an OR of 1,53(95% CI 1,35 to 1,75), small size at birth with an OR of 1,22 (95% IC : 1,00 to 1,48), perinatal mortality with an OR of 1,84(95% IC 1,25 to 2,72), preeclampsia with an ORof 1,46 (95% IC 1,06 to 1,85) , cesarean with an OR of 1,52 (95%IC 1,25 to 1,85). We did not find a higher risk of congenital malformation , hypertension or instrumental delivery. A higher risk of pregnancy outcomes seems to be showed before the disease onset. Furthermore, disease activity and drug treatment such as NSAIDs and corticosteroids should decrease fertility and increase pregnancy outcomes and specially prematurity and miscarriage.

Conclusion: A significative higher risk of several pregnancy outcomes in women with Rheumatoid Arthritis . Rheumatologist should be advised of these risks to refer women in apropriate obstectrics department. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-outcomes-in-women-with-rheumatoid-arthritis-a-systematic-review-and-meta-analyses/