Chock Eugenia Yupei, Glintborg Bente, Liew Zeyan, Pedersen Lars Henning, Thunbo Mette Østergaard
Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, 300 Cedar Street, New Haven, CT 06520, USA.
DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen Rigshospitalet, 2100 Glostrup, Denmark.
Healthcare (Basel). 2024 Nov 28;12(23):2390. doi: 10.3390/healthcare12232390.
Patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are at a twice-higher risk of developing adverse pregnancy outcomes, such as preterm births and infants with a low birth weight. We aimed to evaluate fetal growth among patients with and without rheumatoid arthritis and juvenile idiopathic arthritis (RA and JIA). We conducted a population-based cohort study in Denmark from 2008-2018, which included 503,491 singleton pregnancies. Among them, 2206 were pregnancies of patients with RA and JIA. We linked several nationwide databases and clinical registries in Denmark to achieve our aim. First, we used the International Classification of Diseases-10 codes to identify pregnant patients with RA and JIA from the National Patient Registry. Next, we obtained fetal biometric measurements gathered from second-trimester fetal ultrasound scans and birthweights through the Fetal Medicine Database. Finally, we computed a fetal growth gradient between the second trimester and birth, using the mean difference in the Z-score distances for each fetal growth indicator. We also calculated the risk of small for gestational age (SGA). All outcomes were compared between pregnant individuals with and without RA and JIA, adjusted for confounders. Maternal RA and JIA were not associated with a reduction in the estimated fetal weight (EFW) at 18 to 22 weeks of gestational age [adjusted mean EFW Z-score difference of 0.05 (95% CI 0.01, 0.10)]. We observed reduced mean Z-score differences in the weight gradient from the second trimester to birth among offspring of patients with RA and JIA who used corticosteroids [-0.26 (95% CI -0.11, -0.41)] or sulfasalazine [-0.61 (95% CI -0.45, -0.77)] during pregnancy. Maternal RA and JIA were also associated with SGA [aOR of 1.47 (95% CI 1.16, 1.83)] and the risk estimates were higher among corticosteroid [aOR 3.44 (95% CI 2.14, 5.25)] or sulfasalazine [(aOR 2.28 (95% CI 1.22, 3.88)] users. Among pregnant patients with RA and JIA, fetal growth restriction seemed to occur after 18 to 22 weeks of gestational age. The second half of pregnancy may be a vulnerable period for optimal fetal growth in this population.
类风湿关节炎（RA）和幼年特发性关节炎（JIA）患者发生不良妊娠结局的风险高出两倍，如早产和低出生体重儿。我们旨在评估患有和未患类风湿关节炎及幼年特发性关节炎（RA和JIA）患者的胎儿生长情况。我们于2008年至2018年在丹麦进行了一项基于人群的队列研究，纳入了503,491例单胎妊娠。其中，2206例为RA和JIA患者的妊娠。我们连接了丹麦几个全国性数据库和临床登记处来实现我们的目标。首先，我们使用国际疾病分类第10版代码从国家患者登记处识别患有RA和JIA的孕妇。接下来，我们通过胎儿医学数据库获得了孕中期胎儿超声扫描收集的胎儿生物测量数据和出生体重。最后，我们使用每个胎儿生长指标的Z评分距离的平均差异计算孕中期和出生之间的胎儿生长梯度。我们还计算了小于胎龄儿（SGA）的风险。在对混杂因素进行调整后，比较了患有和未患RA和JIA的孕妇的所有结局。母亲患有RA和JIA与孕18至22周时估计胎儿体重（EFW）降低无关[调整后的平均EFW Z评分差异为0.05（95%CI 0.01, 0.10）]。我们观察到，在孕期使用皮质类固醇[-0.26（95%CI -0.11, -0.41）]或柳氮磺胺吡啶[-0.61（95%CI -0.45, -0.77）]的RA和JIA患者的后代中，从孕中期到出生的体重梯度的平均Z评分差异降低。母亲患有RA和JIA也与SGA相关[aOR为1.47（95%CI 1.16, 1.83）]，在使用皮质类固醇[aOR 3.44（95%CI 2.14, 5.25）]或柳氮磺胺吡啶[(aOR 2.28（95%CI 1.22, 3.88）]的患者中风险估计更高。在患有RA和JIA的孕妇中，胎儿生长受限似乎发生在孕18至22周之后。妊娠后半期可能是该人群胎儿最佳生长的脆弱期。
