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Abstract Number: 2432

Peripartum Issues in the Inflammatory Arthritis (IA) Patient: A Survey of the Rapport (Rheumatoid Arthritis Pharmacovigilence Program and Outcomes Research in New Therapies) Registry

Tharindri Dissanayake1, Stephanie Keeling2 and Walter P. Maksymowych3, 1Department of Medicine, University of Alberta, Division of Rheumatology, Edmonton, AB, Canada, 2Department of Medicine, University of Alberta, University of Alberta, Edmonton, AB, Canada, 3CaRE Arthritis, Edmonton, AB, Canada

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: inflammatory arthritis, pregnancy, rheumatoid arthritis (RA) and therapy

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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


Disclosure: T. Dissanayake, None; S. Keeling, None; W. P. Maksymowych, CaRE rthritis, 9.

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.
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