Session Information
Date: Tuesday, October 23, 2018
Session Title: Reproductive Issues in Rheumatic Disorders Poster
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Multiple issues surround the peripartum period for IA patients including medication use, risk of disease flare and potential impact on neonatal outcomes. We aimed to better understand these issues by surveying childbearing women with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in a biologic registry.
Methods:
A retrospective survey of 440 peripartum females of less than 50 years of age with RA or PsA in the RAPPORT registry was performed using an anonymous electronic-based RedCAp survey. Descriptive statistics and Fisher’s exact test were used to analyze the results.
Results:
162 patients (133 RA/29 PsA) completed the survey (103 women having 234 pregnancies), 164 pregnancies occurring before and 70 pregnancies occurring after IA diagnosis. Pregnancy outcomes from 103 patients included: 96% live births, 1.9% stillbirths, 23% miscarriages, and 15% therapeutic abortions. A third of patients had fewer children than desired due to IA disease activity, medications and other reasons. For 63 pregnancies after IA diagnosis: (1) 49% of pregnancies received pre-conception counseling; (2) most described good IA disease control during pregnancy but flared in the first 3 months postpartum; (3) 79% of pregnancies discontinued IA medications; (4) 35% of pregnancies occurred on biologic therapy at or prior to conception. Gestational age at time of delivery was 37-40 weeks in 58% (33/57) post-IA vs 66% (83/126) pre-IA diagnosis pregnancies. No statistically significant differences occurred between pregnancies before or after IA diagnosis for: pregnancy planning, fertility treatment, pregnancy and labour/delivery complications, birth defect frequency or neonatal complications. Neonatal ICU admissions were significantly lower in pre-IA diagnosis pregnancies compared to post-IA diagnosis pregnancies. No pregnancy complications were noted in 24/54 pregnancies on medications compared to 6/9 pregnancies not on medications.
Conclusion:
Women with RA and PsA are faced with multiple peripartum issues emphasizing the importance of informed decision-making before, during and after pregnancy.
Table 1. Characteristics of RAPPORT Survey Patients
|
Type of IA # (%) |
RA |
133 (82.1) |
|
PsA |
29 (17.8) |
|
|
Age Range (years) |
< 19 |
1 (0.6) |
|
20-30 |
17 (10.5) |
|
|
31-40 |
55 (34) |
|
|
41-50 |
89 (36.4) |
|
|
Antibodies # (%) |
RF+ |
59 (36.4) |
|
Anti-CCP + |
6 (3.7) |
|
|
RF & anti-CCP + |
13 (8) |
|
|
Do not recall |
84 (51.9) |
|
|
Pregnancy Outcomes # (%) |
Live Births |
99 (96) |
|
Stillbirths |
2 (1.9) |
|
|
Miscarriages |
23 (22.3) |
|
|
Abortions |
15 (14.5) |
|
|
Total # pregnancies per patient # (%) |
1 |
29 (27.2) |
|
2 |
40 (38.8) |
|
|
3 |
23 (22.3) |
|
|
4 |
6 (5.8) |
|
|
5-6 |
6 (5.8) |
Table 2. Detailed Pregnancy Outcomes
|
All patients with pregnancies Mean +/- SD |
Patients with less children than desired (34/103) Mean +/- SD |
Patients with expected number of pregnancies (69/103) Mean +/- SD |
|
|
Total pregnancies |
2.27 +/- 1.18 |
1.97 +/- 1.36 |
2.42 +/- 1.46 |
|
Live pregnancies |
1.78 +/- 0.83 |
1.41 +/- 1.03 |
1.96 +/- 1.11 |
|
Stillbirths |
0.03 +/- 0.14 |
0.03 +/- 0.41 |
0.02 +/- 0.08 |
|
Miscarriages |
0.29 +/- 0.64 |
0.38 +/- 0.56 |
0.26 +/- 0.45 |
|
Therapeutic abortions |
0.17 +/- 0.45 |
0.15 +/-0.49 |
0.19 +/- 0.49 |
Table 3. Pregnancy variables in pre-and post IA pregnancies
|
Number (%) of pregnancies prior to IA diagnosis |
Number (%) of pregnancies post IA diagnosis |
P value |
|
|
Planed pregnancy |
107 (69.9) |
46 (73.0) |
P=0.74 |
|
Time to pregnancy 0-2 months |
49 (45.8) |
19 (41.3) |
P=0.72 |
|
Infertility treatment |
13 (8.7) |
2 (3.2) |
P=0.24 |
|
37-40 weeks Gestational age at delivery |
83 (65.8) |
33 (57.9) |
P=0.32 |
|
No pregnancy complications |
86 (56.2) |
30 (47.6) |
P = 0.29 |
|
Labour and delivery complications |
28 (22.2) |
15 (26.3) |
P =0.58 |
|
C-section Delivery |
27 (21.3) |
17 (29.8) |
P=0.26 |
|
Low birth weight (<2.5kg) |
6 (4.8) |
4 (7.0) |
P=0.50 |
|
Breast feeding |
96 (76.2) |
46 (80.7) |
P=0.57 |
|
Birth defects |
8 (6.3) |
3 (5.5) |
P=1.00 |
|
Neonatal medical complications |
19 (15.1) |
12 (21.8) |
P=0.29 |
|
Neonatal ICU admissions |
4 (3.2) |
8 (14.5) |
P=0.0082 |
To cite this abstract in AMA style:
Dissanayake T, Keeling S, Maksymowych WP. Peripartum Issues in the Inflammatory Arthritis (IA) Patient: A Survey of the Rapport (Rheumatoid Arthritis Pharmacovigilence Program and Outcomes Research in New Therapies) Registry [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/peripartum-issues-in-the-inflammatory-arthritis-ia-patient-a-survey-of-the-rapport-rheumatoid-arthritis-pharmacovigilence-program-and-outcomes-research-in-new-therapies-registry/. Accessed January 31, 2023.« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/peripartum-issues-in-the-inflammatory-arthritis-ia-patient-a-survey-of-the-rapport-rheumatoid-arthritis-pharmacovigilence-program-and-outcomes-research-in-new-therapies-registry/