medwireNews: Pregnant women with rheumatoid arthritis (RA) who follow an “ideal clinical pathway” restore their risk for adverse pregnancy outcomes to that expected for the general population, suggest findings from an observational study.
The analysis of the RECORD dataset included 443 women with RA who were pregnant for the first time in 2004–2013, 31.8% of whom were categorized as having followed the ideal clinical pathway for optimal pregnancy management.
The authors defined the ideal pathway as according to the presence of three indicators:
- diagnosis with laboratory blood tests, musculoskeletal imaging, and tests for antiphospholipid, extractable nuclear antigen, and antinuclear antibodies;
- treatment based on no exposure or wash-out from methotrexate and leflunomide, and no exposure to biologic drugs from conception to delivery; and
- prenatal follow-up with at least one visit to a rheumatologist.
After adjustment for factors including age and comorbidities, the 141 women who adhered to the ideal pathway had a significant 40% lower risk for adverse pregnancy outcomes (complicated birth, pregnancy loss, or perinatal death) than the 302 who did not, with rates of 29% versus 38%.
And when a cohort of 6097 women without RA from the same dataset was used as a comparator, there was no significant difference in the risk for adverse pregnancy outcomes among RA patients who adhered to the ideal pathway and the healthy controls (adjusted odds ratio=0.92).
On the other hand, patients who did not adhere to the ideal pathway had a significant 1.5-fold elevated risk for adverse pregnancy outcomes than those without RA.
Carlo Alberto Scirè (University of Ferrara, Italy) and fellow researchers found that of the three indicators of optimal pregnancy management, appropriate treatment was the factor most strongly associated with decreased rates of adverse outcomes, conferring a significant 72% risk reduction.
“This reinforces the importance of adjustment of therapy for RA before conception and throughout pregnancy, because medication use could affect pregnancy course not only influencing maternal disease activity but also the gestational outcome,” they write in Arthritis Care & Research.
The researchers also investigated the more specific outcome of miscarriage/perinatal death, finding a similar pattern of results to that observed for overall adverse pregnancy outcomes.
They conclude that “adherence to an ideal clinical pathway should be strived for as much as possible in order to offer the best possible chances for a successful pregnancy to women with RA.”
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