Aljary Hissah, Czuzoj-Shulman Nicholas, Spence Andrea R, Abenhaim Haim A
Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University Montreal, Montreal, Canada.
Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.
J Matern Fetal Neonatal Med. 2020 Feb;33(4):618-624. doi: 10.1080/14767058.2018.1498835. Epub 2018 Sep 6.
To assess if pregnancies in women with rheumatoid arthritis (RA) are at a higher risk for adverse maternal and neonatal outcomes. A retrospective cohort study was carried out using the Healthcare Cost and Utilization Project - National Inpatient Sample (HCUP-NIS) from the USA. All births that took place from 2004 to 2013 were identified and women were classified as having RA or not on the basis of ICD-9 coding. Unconditional logistic regression was used to evaluate the adjusted effect of RA on maternal and neonatal outcomes. Of the total 8,417,607 births in our cohort, 6068 were among women with RA for an overall prevalence of 72 per 100,000 births. There was a steady increase in reported RA in pregnancy from 47 to 100 per 100,000 over the 10-year study period. Compared with women without RA, women with RA were more likely to develop pre-eclampsia/eclampsia, gestational diabetes, to present with preterm premature rupture of membranes(PPROM), to experience placental abruption and placenta previa, and to deliver by caesarean section. Postpartum, RA-complicated pregnancies were associated with wound complications and thromboembolisms. Congenital anomalies, small for gestational age and preterm birth were more common in neonates of women with RA. RA in pregnancy is associated with a greater likelihood of adverse maternal and neonatal outcomes. Women with RA should be made aware of these risks and be followed as a high risk pregnancy.
评估类风湿关节炎（RA）女性的妊娠是否具有更高的孕产妇和新生儿不良结局风险。利用美国医疗成本和利用项目-全国住院患者样本（HCUP-NIS）进行了一项回顾性队列研究。确定了2004年至2013年期间发生的所有分娩，并根据ICD-9编码将女性分为患有RA或未患RA。采用无条件逻辑回归来评估RA对孕产妇和新生儿结局的调整效应。在我们队列中的8417607例分娩中，6068例发生在患有RA的女性中，总体患病率为每10万例分娩中有72例。在10年的研究期间，报告的妊娠合并RA的患病率从每10万例中的47例稳步上升至100例。与未患RA的女性相比，患RA的女性更有可能发生子痫前期/子痫、妊娠期糖尿病，出现胎膜早破（PPROM）、胎盘早剥和前置胎盘，并进行剖宫产。产后，RA合并妊娠与伤口并发症和血栓栓塞有关。先天性异常、小于胎龄儿和早产在患RA女性的新生儿中更为常见。妊娠合并RA与孕产妇和新生儿不良结局的可能性更大有关。应让患RA的女性了解这些风险，并作为高危妊娠进行随访。
