Impact of Rheumatoid Arthritis on Pregnancy Outcomes: Increased Risks of Abortion and Low Birth Weight in a Prospective Case-Control Study

TL;DR

Women with rheumatoid arthritis face higher risks of miscarriage, preterm birth, and low birth weight during pregnancy compared to healthy controls.

Contribution

This study provides new evidence on the adverse pregnancy outcomes specifically linked to rheumatoid arthritis in a prospective case-control design.

Findings

RA was associated with a 19.8% miscarriage rate compared to 0.9% in controls.

RA increased the likelihood of low birth weight by threefold.

RA was linked to higher rates of preterm birth and caesarean delivery.

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease posing significant challenges for women of childbearing age. This study investigated the impact of RA on pregnancy outcomes.

A prospective case-control study was conducted at Hamad General Hospital, Qatar, from January 2016 to December 2021. It involved pregnant women with a confirmed diagnosis of RA and healthy pregnant controls. Data were collected through patient interviews and electronic medical records.

A total of 327 participants were included: 101 women with RA and 226 healthy pregnant controls. The mean disease duration among RA patients was 6.23±4 years. Active disease, defined by a Clinical Disease Activity Index > 2.8, was observed in 30.7% of patients in the second trimester and 26.7% in the third. Women with RA had significantly higher rates of miscarriage (19.8% vs. 0.9%; P<0.001), preterm birth (24.8% vs. 14.2%; P<0.001), and caesarean delivery (31.7% vs. 14.6%; P < 0.001) compared to controls. Multivariate analyses showed that RA was significantly associated with increased risks of a composite adverse pregnancy outcome, including miscarriage, intrauterine foetal demise, or intrauterine growth restriction (coefficient, B=2.876; P<0.001). Additionally, RA was linked to a threefold increase in the likelihood of low birth weight (OR=3.088; P=0.023) but a lower risk of neonatal morbidity (OR=0.385; P=0.034).

RA adversely affects pregnancy outcomes, including higher risks of miscarriage, low birth weight, and preterm birth. These findings underscore the need for specialised prenatal care and close monitoring of disease activity and treatment during pregnancy to optimise maternal and neonatal outcomes.