What Women with Rheumatoid Arthritis Can Do to Have Healthy Pregnancies


Investigators identified 7 healthcare quality indicators, “the ideal clinical pathway,” for patients with rheumatoid arthritis to reduce the risk of birth complications.


Women with rheumatoid arthritis (RA) who followed an ideal clinical pathway of certain medical tests, therapies, and prenatal follow-up had a 40% lower risk of complicated birth or miscarriage compared to those who did not, according to new research.

Senior author Carlo Alberto Scirè, MD, PhD, of the University of Ferrara in Italy, and colleagues studied women with and without RA to assess the effect of optimal pregnancy management on the outcome of miscarriage and complicated birth. Women with RA who followed the ideal pathway—stratification of pre-conceptual obstetric risk, modulation of therapy, and prenatal rheumatological follow-up—had a reduced risk of overall adverse pregnancy outcome (APO) with an OR = .40 (95% CI, .24—.69) compared to those who did not.

The findings of the study suggest that interventions could have a relevant impact on a successful pregnancy for women with RA, Scirè said in a statement.

The investigators identified 7 healthcare quality indicators grouped in diagnostic, therapeutic, and prenatal follow-up pathways, based on recommendations developed in other rheumatic conditions. The indicators included:

  • Having at least 1 blood lab test performed within 18 months before conceiving and the date of delivery or miscarriage
  • Pre-conception musculoskeletal imaging
  • Pre-pregnancy aPL tests
  • ANA test and anti-ENA test
  • No exposure or wash-out from teratogenic drugs indicated by the absence of redemption between 6 months before pre-conception and delivery or miscarriage date
  • No exposure to biological drugs
  • Rheumatologic monitoring and follow-up via outpatient visits

Scirè and the team extracted data of females with RA and control women between 18—50 years old from the RECord-linkage on Rheumatic Diseases dataset. The investigators collected demographic information; redeemed prescriptions; disease certification; outpatient visits; and hospital discharge forms with information on the date of delivery or miscarriage.

Overall, the study included 443 patients with RA and 6097 control patients who belonged to the general population. The mean maternal age of the patients was 34 years old (RA interquartile range 31—37, general population interquartile range 30–37).

Patients with RA had a significantly higher frequency of thyroid diseases, overall APO, and miscarriage or perinatal death compared to the general population. The patients with RA in the ideal pathway were more exposed to treatment (no treatment in 56 patients in ideal pathway [39.7%] versus 199 cases not in ideal pathway [65.9%] P <.001).

There was a reduced risk of overall APO among patients with RA who followed the ideal clinical pathway with an adjusted OR = .60 (95% CI, .39—.94). These patients also had a reduced risk of miscarriage or perinatal death with an adjusted OR = .40 (95% CI, .24–.69) compared to those who did not adhere.

Among the 3 pathways, the therapeutic pathway was the was the main factor associated with overall APO with an adjust OR = .28 (95% CI, .14—.55) and with miscarriage or perinatal death with an adjusted OR = .22 (95% CI, .11–.46). Patients with RA who met all 3 pathway indicators had a risk of APO with an adjusted OR = .92 (95% CI, .61–1.38).

Adherence to the ideal clinical pathway in women with RA restored the risk of APO to what was expected for the general population, the investigators concluded.

The study, “Improved pregnancy outcome in patients with Rheumatoid Arthritis who followed an ideal pathway,” was published online in the journal Arthritis Care & Research.

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