Rheumatology, Erasmus MC, Rotterdam, Netherlands
Rheumatology, Erasmus MC, Rotterdam, Netherlands.
RMD Open. 2020 Jul;6(2). doi: 10.1136/rmdopen-2020-001276.
To describe parenting disability postpartum in patients with rheumatoid arthritis (RA) using the Parenting Disability Index and to determine early in pregnancy which patients will face parenting problems postpartum.
Data were collected from a prospective study on pregnancy and RA (Pregnancy induced Amelioration of Rheumatoid Arthritis study). Postpartum visits were performed at 6, 12 and 26 weeks after delivery. Domains causing parenting difficulties were identified. A multivariate logistic regression model to identify which patients develop parenting disabilities postpartum with patient characteristics in the first trimester as covariates was performed.
148 patients were eligible for this study. The domains carrying, hygiene, feeding, getting up and down, and household/shopping were frequently scored as difficult. Maintaining discipline, taking care of the children when sick, listening and having other children over caused the least problems. 30.1% of patients with RA report low parenting disability, 30.9% reports intermediate disability and 39.0% reports high disability. Patients with a low Health Assessment Questionnaire (HAQ)-score in the first trimester (OR 9.2, 95% CI 3.0 to 27.7, p<0.001) and low disease activity in the first trimester (Disease Activity Score 28-joint count C reactive protein<3.2) (OR 4.8, 95% CI 1.8 to 12.9, p=0.002) were likely to report low parenting disability postpartum. Patients with a longer disease duration (OR 0.87, 95% CI 0.79 to 0.95, p=0.003) were less likely to report low parenting disability postpartum. A high HAQ-score in the first trimester (OR 4.54, 95% CI 1.99 to 10.34, p<0.001) and erosive disease (OR 2.32, 95% CI 1.00 to 5.35, p=0.049) increased the risk of high parenting disability postpartum.
Physical domains of parenting postpartum are most commonly affected in patients with RA. When counselling patients with RA, a HAQ-score in the first trimester is the most reliable marker to identify patients that develop parenting disability after delivery.
使用育儿障碍指数（Parenting Disability Index）描述产后类风湿关节炎（RA）患者的育儿障碍，并确定哪些患者在孕期较早时会面临产后育儿问题。
本研究数据来自一项关于妊娠和 RA 的前瞻性研究（妊娠诱导 RA 缓解研究）。在产后 6、12 和 26 周进行产后访视。确定导致育儿困难的领域。使用多元逻辑回归模型，以患者在孕早期的特征作为协变量，识别哪些患者在产后会出现育儿障碍。
共有 148 名患者符合研究条件。携带、卫生、喂养、上下床和家务/购物等领域经常被评为困难。维持纪律、照顾生病的孩子、倾听和有其他孩子来访则造成的问题最少。30.1%的 RA 患者报告低育儿障碍，30.9%报告中度障碍，39.0%报告高障碍。在孕早期健康评估问卷（Health Assessment Questionnaire，HAQ）评分较低的患者（OR 9.2，95%CI 3.0 至 27.7，p<0.001）和孕早期疾病活动度较低的患者（疾病活动评分 28 关节计数 C 反应蛋白<3.2）（OR 4.8，95%CI 1.8 至 12.9，p=0.002），更有可能报告产后低育儿障碍。疾病病程较长的患者（OR 0.87，95%CI 0.79 至 0.95，p=0.003）不太可能报告产后低育儿障碍。孕早期 HAQ 评分较高（OR 4.54，95%CI 1.99 至 10.34，p<0.001）和存在侵蚀性疾病（OR 2.32，95%CI 1.00 至 5.35，p=0.049）增加了产后高育儿障碍的风险。
产后 RA 患者最常受到育儿身体方面的影响。在为 RA 患者提供咨询时，孕早期的 HAQ 评分是识别产后出现育儿障碍的最可靠指标。
