Background/Purpose: To analyze pregnancy complications, pregnancy outcome and delivery mode in patients with rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA).

Methods: Patients with RA and axSpA were compared with those of matched healthy controls (HC) with respect to pregnancy complications, pregnancy outcome and delivery mode. Patients and controls were prospectively followed at the University of Bern once at each trimester and two months postpartum. To identify risk factors for adverse pregnancy outcomes and delivery modes, multivariable logistic regression analyses were performed. Differences in birth weight of neonates in patients and references were examined in multivariable linear regression analyses.

Results: We analyzed 244 pregnancies, of which 96 pregnancies occurred in 86 RA patients, 78 in 70 axSpA patients and 70 in 70 healthy women. Compared with healthy pregnant controls, pregnant women with RA and axSpA showed a higher risk for pregnancy complications (gestational diabetes, preeclampsia, infection, preterm premature rupture of membranes) as well as for small for gestational age infants and for preterm deliveries. Active disease in both RA and axSpA was a risk factor for preterm delivery. Compared to neonates born to healthy mothers, those born to women with RA showed a mean reduction in birth weight of 414.4 gm and those born to women with axSpA had a mean reduction in birth weight of 254.4 gm. Regarding delivery mode, most women had vaginal deliveries (RA: 51.0%, axSpA: 57.7%, HC: 72.9%). We found an increased risk of caesarean section (C section) in women with RA compared with healthy controls which was not seen in axSpA patients. The risk of elective C section and emergency C section was not increased in RA and axSpA patients compared to the healthy control group.

Conclusion: Autoimmune inflammatory diseases such as RA and axSpA are risk factors for adverse pregnancy outcome. Since maternal disease activity is a risk factor for preterm delivery, disease activity should be sufficiently controlled during pregnancy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/influence-of-rheumatoid-arthritis-and-axial-spondyloarthritis-on-pregnancy-complications-pregnancy-outcome-and-delivery-mode/