Factors Associated With Preterm Delivery Among Women With Rheumatoid Arthritis and Women With Juvenile Idiopathic Arthritis
Factors Associated With Preterm Delivery Among Women With Rheumatoid Arthritis and Women With Juvenile Idiopathic Arthritis
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DOI：
10.1002/acr.23730
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发表时间：
2019-08-01
影响因子：
4.7
通讯作者：
Chambers, Christina D.
中科院分区：
文献类型：
--
作者：
Smith, Chelsey J. F.;Foerger, Frauke;Chambers, Christina D.
目的妊娠期炎性关节炎患者发生早产的风险增加，但其原因尚不清楚。这项前瞻性队列研究的目的是分析孕妇类风湿性关节炎（RA），幼年特发性关节炎（JIA），或健康的比较妇女的疾病活动，药物使用和合并症的妊娠条件对PTD风险的独立影响。方法妇女在19周前完成妊娠作为畸形学信息专家组织（奥蒂斯）妊娠期自身免疫性疾病项目的一部分。妊娠事件、药物、疾病活动和结局的数据通过母亲报告获得，并通过医疗记录进行验证。泊松回归稳健的标准误估计的风险比（RR），多变量调整的风险比（ARR）和95%置信区间（95% CI）。结果从2004年到2017年，共有657名RA女性，170名JIA女性和564名无自身免疫性疾病的对照女性分娩活产婴儿。RA组和JIA组PTD风险均高于对照组（RR分别为2.09 [95% CI 1.50-2.91]和RR 1.81 [95% CI 1.14-2.89]）。入组时（ARR 1.58 [95% CI 1.10-2.27]）和妊娠期间任何时间（ARR 1.52 [95% CI 1.06-2.18]）的活动性RA与PTD相关。在两个关节炎组中，每三个月使用皮质类固醇与PTD风险增加约2- 5倍相关，与疾病活动无关。结论女性RA和女性JIA患者发生PTD的危险性增加。母体疾病活动和皮质类固醇的使用可能会导致这种过度风险。
Objective Pregnant women with inflammatory arthritis may be at increased risk for preterm delivery (PTD), yet it is unclear what drives this risk. This aim of this prospective cohort study of pregnant women with rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), or healthier comparison women was to analyze the independent effects of maternal disease activity, medication use, and comorbid pregnancy conditions on PTD risk. Methods Women were enrolled before 19 weeks completed gestation as part of the Organization of Teratology Information Specialists (OTIS) Autoimmune Disease in Pregnancy Project. Data on pregnancy events, medications, disease activity, and outcomes were obtained by maternal report and validated by medical records. Poisson regression with robust standard errors estimated risk ratios (RR), multivariable adjusted risk ratios (ARRs), and 95% confidence intervals (95% CIs). Results A total of 657 women with RA, 170 with JIA, and 564 comparison women without autoimmune disease who delivered live born infants, from 2004 to 2017 were included for analysis. Both the RA and JIA groups had an increased risk of PTD versus the comparison group (RR 2.09 [95% CI 1.50-2.91] and RR 1.81 [95% CI 1.14-2.89], respectively). Active RA at enrollment (ARR 1.58 [95% CI 1.10-2.27]) and any time during pregnancy (ARR 1.52 [95% CI 1.06-2.18]) was associated with PTD. Corticosteroid use in every trimester was associated with an approximate 2- to 5-fold increased risk for PTD for both arthritis groups, independent of disease activity. Conclusion Women with RA and women with JIA are at increased risk for PTD. Maternal disease activity and corticosteroid use may contribute to some of this excess risk.