Parent, infant postpartum rehospitalization more common in patients with RA, lupus
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Adverse events and outcomes are more common in pregnant patients with rheumatoid arthritis and systemic lupus erythematosus, and their infants, vs. those without rheumatic diseases, according to data published in Arthritis Care & Research.
“I have had interest in improving birth outcomes among women with rheumatic diseases,” Namrata Singh, MD, MSCI, of the division of rheumatology at the University of Washington, in Seattle, told Healio. “We realized that the state of Washington also maintains records of rehospitalizations within 2 years after birth. This has not been evaluated, to my knowledge, in pregnant women with rheumatic diseases and so we undertook this study.”
To compare adverse birth outcomes and rehospitalization among pregnant patients with and without RA and SLE, and their offspring, Singh and colleagues conducted a population-based, retrospective study of individuals who gave birth to single infants from 1987 through 2014. The researchers used Washington State birth hospital discharge data, which include patient and discharge information. To make the file viable, the Singh and colleagues identified all patients with a live birth record in Washington during the study period. Files were screened for patients with a diagnosis classification of RA or SLE.
Files included information on maternal health and economic information, including the age of the birthing parent at the time of delivery, as well as marital status, education achievement level, Medicaid status, number of previous pregnancies and births, prior fetal deaths, prenatal smoking and pre-pregnancy BMI. Additionally, the researchers noted previous use of fertility treatments, adequacy of gestational weight gain, gestational length and prenatal care adequacy scores.
The analysis included 1,223 patients with RA and 1,354 patients with SLE. According to the researchers, RRs were generally greatest among with patients with SLE, compared with RA or those without either. Patients with RA, at 4% (RR = 2.22; 95% CI, 1.62-3.04), or SLE, at 6% (RR = 2.78; 95% CI, 2.15-3.59), required rehospitalization more often than patients without those diseases, especially within 6 months postpartum. Parental rehospitalizations were most common for musculoskeletal conditions, the researchers wrote.
In addition, children of patients with SLE were more likely to demonstrate malformations (RR = 1.46; 95% CI, 1.21-1.75) and increased mortality before 2 years (RR = 2.11; 95% CI, 1.21-3.67). Children of patients with SLE also had more frequent rehospitalizations during the first year of life.
“We observed that women with RA and SLE had increased risk of adverse pregnancy outcomes such as preeclampsia and Cesarean deliveries, compared to women without these diagnoses,” Singh said. “However, the proportion of women with RA or SLE with these complications was small.
“Hospitalizations are burdensome for the patients, their caregivers, and the healthcare system,” she added. “Further research is needed to understand their cause and to develop strategies for preventing rehospitalizations postpartum.”
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