Adverse Impact of Rheumatoid Arthritis on Pregnancy Outcomes: A Saudi Arabia Prospective Multicenter Study

Hanan Al Rayes; Sultana Abdulaziz; Asma Mohammed Alotaibi; Mufaddal Adil Alaithan; Mohammed Attar; Hassan Daghasi; Rand Melibari; Ali H Althagafi; Basant Elnady

doi:10.2147/OARRR.S315867

Adverse Impact of Rheumatoid Arthritis on Pregnancy Outcomes: A Saudi Arabia Prospective Multicenter Study

Open Access Rheumatol. 2021 Jun 15:13:167-175. doi: 10.2147/OARRR.S315867. eCollection 2021.

Authors

Hanan Al Rayes¹, Sultana Abdulaziz², Asma Mohammed Alotaibi³, Mufaddal Adil Alaithan¹, Mohammed Attar⁴, Hassan Daghasi⁴, Rand Melibari², Ali H Althagafi⁴, Basant Elnady^{4

5}

Affiliations

¹ Rheumatology Division, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
² Division of Rheumatology, Department of Medicine, King Fahad Hospital, Jeddah, Saudi Arabia.
³ Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
⁴ Division of Rheumatology, Department of Medicine, Al Hada Armed Forces Hospital, Taif, Saudi Arabia.
⁵ Rheumatology, Rehabilitation and Physical Medicine Department, Faculty of Medicine, Benha University, Benha, Egypt.

Abstract

Background: Rheumatoid arthritis (RA) is associated with adverse pregnancy outcomes and postpartum complications, especially with severe disease activity.

Objective: The current study aimed to compare the pregnancy outcomes in patients with RA and healthy controls as well as to assess the impact of disease-related variables, medications and disease activity on pregnancy and neonatal-related outcomes in the Saudi population.

Methods: This prospective multicenter study included pregnant female patients with RA from three tertiary centers in Saudi Arabia. The demographics, disease activity scoring (DAS28-CRP), medication before and during pregnancy, pregnancy-related outcomes, and complications in comparison to age-matched healthy female controls were noted.

Results: A total of 77 pregnant patients with RA and 250 healthy age-matched pregnant controls were included in the study. A total of 67.53% were in remission before conception (DAS28CRP ≤2.6), and 81.8% of pregnancies were planned. Age of conception, preterm labor, neonatal intensive care unit (NICU) admission and low birth weight were statistically significant (p <0.05) and higher in RA patients than in healthy controls. Longer disease duration (p <0.001), and high C-reactive protein and erythrocyte sedimentation rate levels before conception (p ≤0.001) were statistically associated with preterm NICU admission. There was statistically significant association between mild (p = 0.015) or moderate to severe DAS28-CRP (p = 0.001) and RA patients regarding pregnancy outcomes. The classification table obtained from the logistic model showed patients with mild and moderate-severe DAS28-CRP have significantly high chances of having an adverse pregnancy outcome.

Conclusion: RA has a negative impact on pregnancy-related outcomes. Higher disease activity is considered a major risk; thus, tight disease control should be aimed. Planned pregnancy follow-up is associated with better pregnancy outcomes.

Keywords: disease activity; pregnancy; rheumatoid arthritis.

Grants and funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.