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. 2022 Apr:53:151975.
doi: 10.1016/j.semarthrit.2022.151975. Epub 2022 Feb 2.

Women with Rheumatoid Arthritis have similar rates of postpartum maternal outcomes compared to women without autoimmune disease

Sarah Tarplin  1 , Janie Hubbard  1 , Sarah Green  1 , Raeann Whitney  1 , Lee Wheless  2 , April Barnado  3
Affiliations

Women with Rheumatoid Arthritis have similar rates of postpartum maternal outcomes compared to women without autoimmune disease

Sarah Tarplin et al. Semin Arthritis Rheum. 2022 Apr.

Abstract

Objective: Limited data exist on the effect of rheumatoid arthritis (RA) on maternal postpartum outcomes. Using a real-world, electronic health record (EHR) cohort, we assessed maternal postpartum outcomes in RA.

Methods: In a large, de-identified EHR, we identified possible RA deliveries using ≥1 delivery ICD-9 or ICD-10-CM codes and a validated RA algorithm. RA cases were required to be diagnosed by a rheumatologist on chart review. Maternal postpartum outcomes included rates of blood transfusion, rates of infection up to 6 weeks postpartum defined by a clinician, and length of hospital stay. We also identified deliveries to women without autoimmune diseases.

Results: We identified 202 deliveries occurring after RA diagnosis and 596 deliveries to controls without autoimmune diseases. Postpartum infection rates were similar among RA patients and controls (8% vs. 4%, p = 0.10), as were red blood cell transfusion rates (2% vs. 2%, p = 1.00). RA case status was not significantly associated with postpartum infection (OR = 2.10, 95% CI 0.88 - 4.98, p = 0.09) but was significantly associated with preterm birth (OR = 2.11, 95% CI 1.38 - 3.23, p = 0.001). Corticosteroid use during pregnancy was common at 41%, while tumor necrosis factor inhibitor use was 13%. After adjusting for age at delivery and race, corticosteroid use at delivery was not associated with postpartum maternal infections but was associated with a significantly lower birthweight in RA cases.

Conclusion: Women with RA have an increased risk of adverse pregnancy outcomes, particularly preterm birth. Our study highlights, however, that maternal postpartum outcomes such as postpartum infection and blood transfusion are not significantly increased in RA patients.

Keywords: Birth; Delivery; Electronic health record; Pregnancy; Rheumatoid arthritis.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Figure 1.
Figure 1.. Flow chart of patient selection.
Rheumatoid arthritis (RA) deliveries (A) were identified using a validated RA algorithm and at least one validated pregnancy or delivery-related ICD-9 or ICD-10-CM code (Supplemental Table 1). RA case status was confirmed on chart review and defined by a rheumatologist diagnosis. We identified 331 deliveries to 186 mothers with RA and with available delivery data. Births occurring before RA diagnosis were then excluded resulting in 202 deliveries to 101 mothers. Control pregnancies (B) were identified using at least one ICD-9 or ICD-10-CM delivery code, same as the codes required for RA cases (Supplemental Table 1). We excluded controls who had ICD-9 or ICD-10-CM codes for rheumatoid arthritis or other systemic autoimmune disease (full list of conditions in Supplemental Table 3). We identified approximately 855 control subjects and randomly selected 250 subjects for chart review. We performed chart review to ensure no autoimmune disease and excluded control pregnancies with autoimmune diseases.
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References

    1. Dugowson CE, Koepsell TD, Voigt LF, Bley L, Nelson JL, Daling JR. Rheumatoid arthritis in women. Incidence rates in group health cooperative, Seattle, Washington, 1987–1989. Arthritis Rheum. 1991;34(12):1502–7. 10.1002/art.1780341205. - DOI - PubMed
    1. de Man YA, Hazes JM, van der Heide H, Willemsen SP, de Groot CJ, Steegers EA, et al. Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum. 2009;60(11):3196–206. 10.1002/art.24914. - DOI - PubMed
    1. Rom AL, Wu CS, Olsen J, Kjaergaard H, Jawaheer D, Hetland ML, et al. Fetal growth and preterm birth in children exposed to maternal or paternal rheumatoid arthritis: a nationwide cohort study. Arthritis Rheumatol. 2014;66(12):3265–73. 10.1002/art.38874. - DOI - PMC - PubMed
    1. Bermas BL, Tassinari M, Clowse M, Chakravarty E. The new FDA labeling rule: impact on prescribing rheumatological medications during pregnancy. Rheumatology (Oxford). 2018;57(suppl_5):v2–v8. 10.1093/rheumatology/key010. - DOI - PMC - PubMed
    1. Chakravarty EF, Nelson L, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum. 2006;54(3):899–907. 10.1002/art.21663. - DOI - PubMed

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