Mohamed M A, Goldman C, El-Dib M, Aly H
Newborn Services, The George Washington University Hospital, Washington, DC, USA.
J Perinatol. 2016 Apr;36(4):268-71. doi: 10.1038/jp.2015.193. Epub 2015 Dec 17.
Adverse pregnancy outcomes in mothers with juvenile rheumatoid arthritis (JRA) are not known. The objective of this study was to examine the risk of preterm birth and restricted fetal growth in pregnant mothers diagnosed with JRA, and to examine the impact of race/ethnicity and maternal age on this association.
Hospital discharge records for mothers who gave birth in 2011 and 2012 were examined in the National Inpatient Sample (NIS) database. JRA, preterm birth (<37 weeks of gestation), birth weight that is small for gestational age (SGA) and other demographic and clinical variables were identified using ICD-9 (International Classification of Disease--9th revision) diagnostic codes. The associations of JRA with preterm birth and restricted fetal growth were examined controlling for confounding variables.
The sample included 8,273,987 birthing mothers, of these 1236 (0.01%) had JRA. The prevalence of preterm birth and SGA was 6.08% and 2.34%, respectively. Preterm birth in mothers with JRA was 12.9% compared with 6.1% in mothers without JRA with an adjusted odds ratio (OR) of 2.1 (confidence interval (CI): 1.74 to 2.42, P<0.001). The incidence of SGA in infants born to mothers with JRA was 3.34% compared with 2.34% in non-JRA mothers, which was not statistically significant. Adjusted OR for preterm birth in association with JRA among White mothers was 1.78 (CI: 1.41 to 2.24, P<0.001). However, Hispanic mothers with JRA (12%) were the ethnicity to suffer the most from preterm birth with an adjusted OR of 4.43 (CI: 2.97 to 6.62, P<0.001). Preterm birth among advanced maternal age (AMA) mothers with JRA was 25% compared with 7% in those without JRA with an adjusted OR of 5.42 (CI: 3.51 to 8.35, P<0.001).
JRA is associated with preterm birth but not with SGA. This association is significantly influenced by race/ethnicity and maternal age. More studies are needed to examine these findings in relation to medications used, severity of the disease and exacerbation during pregnancy to understand the genetic/socioeconomic factors behind these racial/ethnic differences.
青少年类风湿性关节炎（JRA）母亲的不良妊娠结局尚不清楚。本研究的目的是调查被诊断为JRA的孕妇早产和胎儿生长受限的风险，并研究种族/民族和母亲年龄对这种关联的影响。
在国家住院患者样本（NIS）数据库中检查了2011年和2012年分娩母亲的出院记录。使用国际疾病分类第九版（ICD-9）诊断代码确定JRA、早产（妊娠<37周）、小于胎龄儿出生体重（SGA）以及其他人口统计学和临床变量。在控制混杂变量的情况下，研究JRA与早产和胎儿生长受限的关联。
样本包括8,273,987名分娩母亲，其中1236名（0.01%）患有JRA。早产和SGA的患病率分别为6.08%和2.34%。患有JRA的母亲早产率为12.9%，而未患JRA的母亲早产率为6.1%，调整后的优势比（OR）为2.1（置信区间（CI）：1.74至2.42，P<0.001）。JRA母亲所生婴儿的SGA发生率为3.34%，而非JRA母亲所生婴儿的SGA发生率为2.34%，差异无统计学意义。白人母亲中JRA与早产相关的调整后OR为1.78（CI：1.41至2.24，P<0.001）。然而，患有JRA的西班牙裔母亲早产率最高（12%），调整后的OR为4.43（CI：2.97至6.62，P<0.001）。高龄产妇（AMA）中患有JRA的母亲早产率为25%，而未患JRA的母亲早产率为7%，调整后的OR为5.42（CI：3.51至8.35，P<0.001）。
JRA与早产相关，但与SGA无关。这种关联受种族/民族和母亲年龄的显著影响。需要更多研究来检查这些发现与所用药物、疾病严重程度和孕期病情加重的关系，以了解这些种族/民族差异背后的遗传/社会经济因素。
