Pregnancy outcome in a cohort of Egyptian women with rheumatoid arthritis

Abstract

Background: Female patients with rheumatoid arthritis (RA) can have successful pregnancies. However, those who experience a higher disease activity during pregnancy and require continued treatment have a potential risk of maternal and neonatal complications. Aim of the work: To assess pregnancy outcome (adverse maternal and neonatal outcomes) in an Egyptian cohort of female RA patients. Patients and methods: Thiscross-sectional study involved 200 female RA patients and 100 healthy age-matched controls. All were subjected to detailed gynecological history including: number of pregnancies, miscarriage, mode of delivery, maternal complication (gestational diabetes and preeclampsia), fetal complication (prematurity, low birth weight ‘LBW’ and congenital anomalies) and medicationsused during pregnancy. The disease activity score (DAS28) was assessed pre-conception and in each trimester. Results: Patients had significantly lower number of pregnancies (p = 0.002) and deliveries (p = 0.001) and higher incidence of miscarriages (p = 0.022) compared to controls. Delivery by Cesarean section (CS) was higher inpatients (p = 0.001) with an increased risk of preeclampsia (p = 0.042). Both the antenatal and natal DAS28 significantly correlatedwith abortions, deliveries by CS and LBW (p = 0.005, p = 0.004 and p < 0.001, respectively). Pre-conceptional methotrexate use significantly correlated with the number of abortions (p = 0.02). Corticosteroid use during pregnancy was related to LBW of newborns (p = 0.03). Conclusion: Pregnant RA patients have higher frequency of abortion, delivery by CS, preeclampsia and LBW of newborns; especially those having higher disease activity and/ortreated with potentially harmful medications. It is crucial to educate female RA patients about these risks and they should be considered as high-risk pregnancy and followed accordingly.