Background/Purpose:

Elevated rheumatoid arthritis (RA) disease activity during pregnancy is associated with lower birth weight and rapid post-natal growth. Lower birth weight and rapid post-natal growth can negatively influence the body composition later in life, creating a negative health profile and hence contribute to cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) in adulthood. Glucocorticoids are one of the few medications that can be given safely during pregnancy, but animal studies have shown a negatively influence on the metabolic profile of the offspring. Whether the same holds true for humans is not known. The purpose of the study was to investigate if RA disease activity or medication during pregnancy influences the body composition, or increases the presence of early risk on CVD or T2DM determinants, in the prepubertal offspring.

Methods:

Children were included if mother participated in a prospective cohort study on RA and pregnancy. In 108 children, approximately 7-years-old, the body compositions were assessed by dual-energy X-ray absorptiometry. The body compositions was expressed in standard deviation score (SDS) for lean body mass (LBM) and fat mass (FM).The presence of the early risk on CVD or T2DM determinants was determined by assessing the individual components (abdominal obesity, high triglyceride, low high-density lipoprotein, high systolic or diastolic pressure and high fasting glucose) of the metabolic syndrome (MetS) adapted for children Independent variables were prednisone, sulfasalazine and RA disease activity during pregnancy.

Results:

The mean LBM SDS was -0.65 (0.70) and FM SDS was, 0.21 (0.94). Both variables were significantly different from 0 SDS, the mean of healthy controls, LBM SDS (p<0.001) and FM SDS (p=0.02).  In multivariate analysis a significant association of gender, birth weight, height  and weight was found (p<0.001) in LBM and only on height and weight (p<0.001) in FM. No association was found between elevated RA disease activity or the presence of medication use during pregnancy. RA disease activity or medication use were also not associated with the individual components of the MetS and only 1 child could be diagnosed with MetS.

Conclusion:

The elevated fat mass compared to the low lean body mass points to a relative higher fat distribution in the prepubertal children born from mothers with RA. Since this was not associated with disease activity or medication use during pregnancy, this could implicate that RA during pregnancy has an impact on the body composition of children through other mechanisms. In addition, prednisone use during pregnancy was not associated with the individual components of the MetS. This underscores that in humans, in contrast to animal studies, corticosteroids do not influence the metabolic profile of the offspring and can hence be prescribed safely.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/does-elevated-disease-activity-or-medication-use-influence-the-body-composition-of-the-prepubertal-offspring-in-pregnant-women-with-rheumatoid-arthritis/