University of Mississippi, 2500 North State Street, Jackson, MS 39232, United States.
University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States.
Semin Arthritis Rheum. 2019 Oct;49(2):236-240. doi: 10.1016/j.semarthrit.2019.03.011. Epub 2019 Mar 23.
Fertility is reduced in patients with Rheumatoid Arthritis due to unknown cause. Few studies have addressed pregnancy outcomes in RA. This study was undertaken to determine the frequency of complications occurring during pregnancy for women with RA and compare with the general obstetric population by using the largest inpatient care database.
By using the 2003-2011 Nationwide Inpatient Sample of Healthcare Cost and Utilization Project, we estimated the number of obstetric hospitalization in women with RA between the age group 18-50 years. Demographic characteristics and in-hospital obstetric complications for all pregnancy-related admissions for women with and without RA were compared. Multivariate logistic regression analysis was used to obtain adjusted odds ratio.
The total number of obstetric hospitalization was 42.32 million of which 31,439 were women with RA. The maternal age of RA population was higher (30.5 years) than that in the control group (27 years). After adjusting for potential confounders, maternal RA population had a significantly higher prevalence of hypertensive diseases, premature rupture of membranes, antepartum hemorrhage, preterm delivery, intrauterine growth retardation and cesarean delivery. The prevalence of postpartum hemorrhage and the risk of inpatient mortality were not different between two groups.
Women with RA have a higher risk of adverse outcomes of pregnancy and thus close antenatal and post-delivery monitoring need to be performed in order to reduce complications. Further studies are needed to examine these findings in relation to severity of disease, medications used and the presence of other comorbidities.
类风湿关节炎患者的生育能力因未知原因降低。少数研究探讨了类风湿关节炎患者的妊娠结局。本研究旨在通过使用最大的住院患者护理数据库，确定类风湿关节炎女性在怀孕期间发生并发症的频率，并与一般产科人群进行比较。
通过使用 2003-2011 年全国住院患者医疗费用和利用项目，我们估计了 18-50 岁年龄组类风湿关节炎女性的产科住院人数。比较了有和没有类风湿关节炎的所有妊娠相关入院患者的人口统计学特征和住院产科并发症。使用多变量逻辑回归分析获得调整后的优势比。
产科住院总人数为 4232 万，其中 31439 人为类风湿关节炎女性。类风湿关节炎患者的母亲年龄（30.5 岁）高于对照组（27 岁）。在调整了潜在混杂因素后，患有母体类风湿关节炎的人群中高血压疾病、胎膜早破、产前出血、早产、宫内生长迟缓以及剖宫产的发生率明显更高。两组患者产后出血的发生率和住院死亡率无差异。
患有类风湿关节炎的女性妊娠不良结局的风险更高，因此需要进行密切的产前和产后监测，以减少并发症。需要进一步研究以检查与疾病严重程度、使用的药物以及其他合并症的存在相关的这些发现。
