medwireNews: The risk for pre-eclampsia is increased in pregnant women with psoriatic arthritis (PsA) or severe rheumatoid arthritis (RA), but not those with axial spondyloarthritis (axSpA), suggests research published in RMD Open.
“Our findings underline the importance of monitoring disease activity in women with RA and PsA before and during pregnancy, especially those with high disease activity and/or antirheumatic treatment prepregnancy,” say Anne Emilie Pape Secher (Rigshospitalet, Glostrup, Denmark) and co-investigators.
The team identified singleton pregnancies in 1739 women with RA, 489 with PsA, and 819 with axSpA between 2006 and 2018 by linking medical birth registers to Swedish (SRQ) and Danish (DANBIO) rheumatology registers.
Each pre-eclampsia pregnancy in the three groups was compared with 10 control pregnancies in women matched for maternal age, parity, and birth year.
In all, there were 69 cases of pre-eclampsia among women with RA, and 26 and 34 and among those with PsA and axSpA, respectively. The risk was increased significantly by 85% among women with PsA and by a nonsignificant 27% and 17% among women with RA or axSpA.
Secher et al found that women with PsA were more often smokers and had a higher BMI than controls and as these factors were adjusted for, they suggest that women with PsA “may carry underlying predisposing factors for pre-eclampsia, apart from factors associated with the underlying disease itself and/or chronic inflammation.”
The significantly increased risk for pre-eclampsia among women with PsA was largely driven by those taking monotherapy before pregnancy, among whom the risk was 172% greater than that for controls, whereas the risk was not significantly increased among those receiving combination treatment or no treatment.
Among women with RA, it was those taking combination treatment (at least two of: conventional synthetic DMARD, biologic DMARD, or oral corticosteroids) before pregnancy who had a significantly increased risk, at 59%, while those receiving monotherapy or no therapy were not at increased risk.
The researchers note that they did not have the “granularity to assess exactly how treatment strategies (ie, continuing or stopping therapy) affected the risk of pre-eclampsia,” but they suggest that “combination therapy prepregnancy is a surrogate of severe disease rather than a risk factor of its own.”
They continue: “This supports the perception that pregnant women with RA should not fear treatment, but rather the disease flares arising from insufficient treatment.”
Indeed, the team found that among the 43% of pregnancies in women with RA for whom measures of HAQ, C-reactive protein (CRP), or DAS28-CRP during pregnancy were available, the risk for pre-eclampsia was almost doubled among those with a high disease load, defined as having a HAQ score of 1 or more, a C-reactive protein level of at least 10 mg/L, or DAS28-CRP of 3.2 or above, compared with control pregnancies.
They point out that as “most patients visit their rheumatologist only once a year (in the case of stable disease), estimates of maternal disease activity and functional status were mainly based on one registration of disease activity (ie, before and during pregnancy).”
There was no significant association between disease load and pre-eclampsia among women with PsA or axSpA, but the team notes that there were a lot of missing data for these groups and the number of events was low.
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