Background/Purpose: Although there is a higher frequency of adverse birth outcomes in women with rheumatoid arthritis, little is known on the subject regarding women who had juvenile idiopathic arthritis ( JIA) as children or adolescents.  The objective of our study was to determine whether children born to women who had JIA in childhood and adolescence had more adverse birth outcomes than children born to mothers who never had JIA.

Methods: We designed a retrospective cohort study using administrative data that covered the entire population of the province of Québec, Canada. We identified 1756 females with a diagnosis of JIA who had given birth (first birth: stillbirth or live birth) between 01/01/1983 and 12/31/2010 from the Quebec physician reimbursement and hospitalization databases. We also assembled a cohort of women from the population database who did not have a diagnosis of JIA,  matched 4:1 for date of first birth (± 3 months), age (± 5 years) and region of residence (using the postal code) to serve as a control group (n=7024). We compared birth outcomes (stillbirth, prematurity, small for gestational age, and the presence of major congenital anomalies diagnosed within the first year post birth) in those who had JIA and those who did not. We used logistic regression, adjusting for maternal age, sex of the infant, maternal education, hypertension during pregnancy and gestational diabetes.

Results: For the entire cohort, the mean age at delivery was 24.9 years (standard deviation 4.4; range 16 to 46 years). There were more adverse birth outcomes in the JIA group, except for stillbirths. Women who had had JIA were at higher risk for having a premature baby (adjusted relative risk (95% confidence interval) 1.18 (1.00,1.4)), a small for gestational age baby (adjusted relative risk (95% confidence interval) 1.19 (1.04-1.36)), and a child with a major congenital anomaly (adjusted relative risk (95% confidence interval) 6.49 (4.88-8.10)). The prevalence of neural tube defects was especially high in the JIA group (1.7% vs 0.04% in the non JIA group) as were congenital heart and circulatory defects (1.2% in the JIA group vs 0.6% in the non JIA group).

Conclusion: Women who had JIA are at higher risk for adverse birth outcomes.  The implications are that women with a history of JIA who are pregnant must be monitored closely. Further research is needed to understand possible pathophysiologic mechanisms in JIA and pregnancy as well as pharmaco-epidemiologic studies to explore the effects of medications during childhood and youth (including during the peri-pubescent period) on future birth outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/birth-outcomes-in-women-with-a-history-of-juvenile-idiopathic-arthritis/