Session Information
Date: Tuesday, November 7, 2017
Title: Epidemiology and Public Health Poster III: Rheumatic Disease Risk and Outcomes
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: The impact of systemic autoimmune rheumatic diseases (SARDS) on peripartum outcomes is not well described at a population level despite the potential for active disease in this period.
Methods: The patient population consisted of women giving birth between January 1, 2005 to December 31, 2014 (n=312,081). For women with multiple gestations during the period, one birth event was randomly selected. Women with SARDs included any of the following: systemic lupus erythematosus, systemic sclerosis, myositis and sjogren’s syndrome, diagnoses based on the presence of International Classification of Disease version 9/10 codes in outpatient or inpatient records. Baseline characteristics, comorbidities, medication use (available for all births after January 1, 2009), and neonatal outcomes among women with and without SARDs were compared
Results: Compared to women with no SARDs (n=311,755), women with SARDs (n=326, 0.1%) were slightly older (SARDs 31.3 vs No SARDs 29.3 years (p<0.01)) but did not differ in terms of rural residence, ethnicity, median household income or nulliparity. However, rates of pre-term delivery, emergent cesearian section, induction, hypertensive disorders/eclampsia and mortality were higher among women with SARDs than those with no SARDs (Table 1). Offspring of women with SARDs had lower birth weights, were more likely small for gestational age (SGA), and had longer stays in neonatal ICU (Table 1). Among women with SARDs, prescription rates in the 270 days prior to delivery were highest for anti-malarials (Table 2). After multivariable adjustment, both NSAIDS use (OR(95% CI): 5.24 (1.57, 17.52), p<0.01) and steroid use (OR(95% CI): 3.15 (1.31, 7.59), p<0.01) were significantly associated with a higher risk of preterm delivery.
Conclusion: Women with SARDs are at an increased risk of adverse outcomes during pregnancy. The association between corticosteroid and NSAID use and preterm delivery requires further investigation. Our findings suggest the need for closer monitoring and coordinated care with obstetrics and perinatology in these high risk women.
| OUTCOME | No SARDs # (%) | SARDs # (%) | P-Value |
| Pre-term Delivery | 22205 (7.1) | 58 (17.8) | < 0.01 |
| C-section (Emergent) | 51132 (16.4) | 82 (25.2) | < 0.01 |
| Hypertensive Disorders | 20029 (6.4) | 47 (14.4) | < 0.01 |
| Small for Gestational Age | 35047 (11.2) | 68 (20.9) | < 0.01 |
| Congenital Anomaly | 5810 (1.9) | 11 (3.4) | 0.05 |
| Mean days in Neonatal ICU | 0.8 (5.0) | 2.3 (9.6) | < 0.01 |
*Sensitivity analysis utilizing primiparious SARDs vs NonSARDs women confirmed similar results
| Outcome | Steroids |
Nonsteroidal Anti-Inflammatories |
Antimalarials |
| # (%) SARDs patients on medication | 33 (16.3) | 13 (6.4) | 51 (25.1) |
| SGA [OR (95% CI)] | 2.06 (0.91, 4.67) | 1.08 (0.29, 4.12) | 1.54 (0.74, 3.20) |
| Gestational Diabetes [OR (95% CI)] | 1.67 (0.51, 5.47) | N/A | 0.91 (0.28, 2.93) |
| Preterm Delivery [OR (95% CI)] | 3.84 (1.66, 8.89)** | 4.96 (1.55, 15.85)** | 1.82 (0.83, 4.00) |
| C-section [OR (95% CI)] | 0.88 (0.41, 1.90) | 0.98 (0.31, 3.11) | 0.57 (0.29, 1.13) |
| Hypertensive Disorders of Pregnancy [OR (95% CI)] | 3.67 (1.51, 8.93)** | 0.50 (0.06, 4.03) | 1.23 (0.51, 2.99) |
To cite this abstract in AMA style:
Keeling S, Savu A, Kaul P. Impact of Maternal Systemic Autoimmune Rheumatic Diseases on Neonatal Outcomes: A Population-Level Analysis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/impact-of-maternal-systemic-autoimmune-rheumatic-diseases-on-neonatal-outcomes-a-population-level-analysis/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-maternal-systemic-autoimmune-rheumatic-diseases-on-neonatal-outcomes-a-population-level-analysis/