Session Information
Title: Rheumatoid Arthritis - Clinical Aspects II: Clinical Features & Comorbidity/Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose: Active rheumatoid arthritis (RA) during pregnancy is associated with lower birth weight. Active RA during pregnancy can be treated with prednisone. However, studies have shown that prednisone use during pregnancy reduces gestational age thereby indirectly creates lower birth weight1. In general, newborns with a lower birth weight will catch-up in growth after they are born. Literature shows that a fast catch-up growth pattern of the child is associated with cardiovascular risk and metabolic disorders in early adulthood2. The purpose of this study: “Is maternal RA and/or prednisone use during pregnancy associated with fast catch-up growth in the first 2 years of the child?”
Methods: Current study is a continuation of a prospective nationwide study on RA during pregnancy. Growth charts were collected from children born from mothers participating in this study. Dependent variable: height standard deviation score (SDS) and weight SDS on different time points. Independent variable: prednisone use and RA disease activity (DAS28) during pregnancy.
Results: 161 growth charts were analyzed; 67 women used prednisone at some point during their pregnancy. The mean DAS28 during pregnancy was significantly higher in the prednisone group, 3.88 (SD: 1.01) than in the group without prednisone 3.02 (SD: 1.03) (p<0.0001).
An association was found between elevated DAS28 during pregnancy and fast catch-up growth (>0.50 SDS) of the child within the first half year. An increase of one point DAS28 during pregnancy resulted in a catch-up weight of 0.16 (p=0.03) and a catch-up height of 0.12 (p=0.04) at the age of 3 months. No effect was shown for prednisone use.
Conclusion: Our study suggests that elevated RA disease activity during pregnancy is associated with fast catch-up growth. This might have lifelong consequences for the child. Minimizing the disease activity during pregnancy is therefore crucial and should be striven at all times.
1. de Man YA, Hazes JM, van der Heide H, et al. Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum. Nov 2009;60(11):3196-3206.
2. Leunissen RW, Kerkhof GF, Stijnen T, Hokken-Koelega A. Timing and tempo of first-year rapid growth in relation to cardiovascular and metabolic risk profile in early adulthood. JAMA. Jun 3 2009;301(21):2234-2242.
Disclosure:
F. D. O. de Steenwinkel,
None;
A. C. S. Hokken-Koelega,
None;
M. A. J. de Ridder,
None;
J. M. W. Hazes,
None;
R. J. E. M. Dolhain,
None.
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