Rheumatoid arthritis (RA) is a chronic autoimmune, inflammatory disease that is more commonly found in women. Our objective is to assess if pregnancies in women with RA are at a higher risk of adverse maternal and neonatal outcomes.METHODS:
We carried out a retrospective cohort study, using the US Healthcare Cost and Utilization Project National Inpatient Sample from 2004-2013. All births were identified and women were classified as having RA or not on the basis of ICD-9 coding. Logistic regression was used to evaluate the adjusted effect of RA on maternal and neonatal outcomes.RESULTS:
Of the total 8,417,607 births in our cohort, 6,068 were among women with RA. There was a steady increase in RA in pregnancy from 47 to 100/100,000 over the 10-year study period. Compared with women without RA, women with RA were more likely to experience pre-eclampsia/eclampsia (OR 1.70, 95% CI 1.54-1.89), gestational diabetes (OR 1.13, 95% CI 1.02-1.24), PPROM (OR 1.78, 95% CI 1.66-1.91), placental abruption (OR 1.43, 95% CI 1.16-1.76), placenta previa (OR 1.37, 95% CI 1.05-1.78), and to deliver by cesarean section (OR 1.38, 95% CI 1.31-1.45). Congenital anomalies (OR 2.11, 95% CI 1.65-2.72), small for gestational age (OR 2.36, 95% CI 2.09-2.66) and preterm birth (OR 1.81, 95% CI 1.67-1.95) were more common in neonates of women with RA.CONCLUSION:
RA in pregnancy is associated with greater likelihood of adverse maternal and neonatal outcomes. Women with RA should be made aware of these risks and be followed as a high risk pregnancy.