medwireNews: Among women with rheumatoid arthritis (RA), corticosteroid use during pregnancy is significantly associated with adverse birth outcomes, study findings indicate.
As reported at the EULAR 2022 Congress in Copenhagen, Denmark, Sabrina Hamroun (Cochin Hospital, Paris, France) and fellow researchers evaluated pregnancy outcomes in 92 women with RA who were included in the French national GR2 cohort between 2015 and 2021. These women were aged an average of 33.7 years with a median disease duration of 5.0 years; 53.8% had previously used a tumor necrosis factor inhibitor and 15.1% other biologics.
In all, 56.5% of these women had a favorable pregnancy outcome, defined as a composite of live birth after at least 37 gestational weeks, a healthy newborn (according to physician’s opinion), and infant weight above the 10th percentile.
The remainder had unfavorable outcomes, such as small for gestational age (SGA) babies (20.5%), preterm birth (<37 gestational weeks; 16.9%), and unhealthy newborns (congenital malformations, respiratory distress, and hypoglycemia; 8.4%). Hamroun remarked that these rates were higher than those in the French general population for SGA (9.8–12.1%) and preterm birth (5.5–6.3%).
The researchers found that the 43 women with at least one corticosteroid exposure during pregnancy had a significantly higher risk for unfavorable pregnancy outcomes than those without, with an odds ratio (OR) of 3.22 after adjustment for factors including age, BMI, nulliparity, disease activity, and biologic exposure during pregnancy.
Older age was also associated with adverse pregnancy outcomes (OR=1.14 per year), as was nulliparity (OR=6.16).
On the other hand, there was no increased risk for adverse pregnancy outcomes among the 39 women who were exposed to biologic DMARDs during pregnancy.
These associations should “make us consider sparing use of corticosteroids during pregnancy in women with RA, and also [preferentially use] pregnancy-compatible steroid-sparing DMARDs,” said Hamroun.
She noted that having moderate or severe disease activity at least once during pregnancy was not associated with adverse outcomes.
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