University of California San Diego, La Jolla, and Cedars-Sinai Medical Center, Los Angeles, California.
University Hospital and University of Bern, Bern, Switzerland.
Arthritis Care Res (Hoboken). 2019 Aug;71(8):1019-1027. doi: 10.1002/acr.23730. Epub 2019 Jul 4.
Pregnant women with inflammatory arthritis may be at increased risk for preterm delivery (PTD), yet it is unclear what drives this risk. This aim of this prospective cohort study of pregnant women with rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), or healthier comparison women was to analyze the independent effects of maternal disease activity, medication use, and comorbid pregnancy conditions on PTD risk.
Women were enrolled before 19 weeks completed gestation as part of the Organization of Teratology Information Specialists (OTIS) Autoimmune Disease in Pregnancy Project. Data on pregnancy events, medications, disease activity, and outcomes were obtained by maternal report and validated by medical records. Poisson regression with robust standard errors estimated risk ratios (RR), multivariable adjusted risk ratios (ARRs), and 95% confidence intervals (95% CIs).
A total of 657 women with RA, 170 with JIA, and 564 comparison women without autoimmune disease who delivered live born infants, from 2004 to 2017 were included for analysis. Both the RA and JIA groups had an increased risk of PTD versus the comparison group (RR 2.09 [95% CI 1.50-2.91] and RR 1.81 [95% CI 1.14-2.89], respectively). Active RA at enrollment (ARR 1.58 [95% CI 1.10-2.27]) and any time during pregnancy (ARR 1.52 [95% CI 1.06-2.18]) was associated with PTD. Corticosteroid use in every trimester was associated with an approximate 2- to 5-fold increased risk for PTD for both arthritis groups, independent of disease activity.
Women with RA and women with JIA are at increased risk for PTD. Maternal disease activity and corticosteroid use may contribute to some of this excess risk.
患有炎症性关节炎的孕妇可能有早产（PTD）的风险增加，但尚不清楚是什么导致了这种风险。本项前瞻性队列研究纳入了类风湿关节炎（RA）、幼年特发性关节炎（JIA）或更健康的对照孕妇，旨在分析母体疾病活动度、药物使用和合并妊娠情况对 PTD 风险的独立影响。
作为组织畸形信息专家（OTIS）妊娠自身免疫性疾病项目的一部分，在妊娠 19 周前，通过母亲报告和病历验证，收集了妊娠事件、药物、疾病活动度和结局的数据。采用稳健标准误差的泊松回归估计风险比（RR）、多变量调整风险比（ARR）和 95%置信区间（95%CI）。
2004 年至 2017 年，共有 657 名 RA 妇女、170 名 JIA 妇女和 564 名无自身免疫性疾病的对照妇女分娩活产婴儿，纳入分析。RA 组和 JIA 组的 PTD 风险均高于对照组（RR 2.09[95%CI 1.50-2.91]和 RR 1.81[95%CI 1.14-2.89]）。入组时的活动期 RA（ARR 1.58[95%CI 1.10-2.27]）和妊娠期间任何时间的疾病活动（ARR 1.52[95%CI 1.06-2.18]）均与 PTD 相关。每个孕期使用皮质类固醇与两组关节炎患者 PTD 的风险增加 2-5 倍相关，且独立于疾病活动度。
RA 和 JIA 妇女 PTD 风险增加。母体疾病活动度和皮质类固醇的使用可能导致了部分额外风险。
