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The risk of pregnancy-related complications is further increased when juvenile arthritis persists into adulthood.
Juvenile onset arthritis that persists into adulthood is strongly associated with pre-eclampsia.
Adult women with persistent juvenile onset arthritis and pre-eclampsia are at increased risk for cesarean delivery, preterm birth, and small for gestational age fetal size.
Prolonged treatment with corticosteroids is associated with preterm delivery and intrauterine growth restriction.
Katarina Remaeus and colleagues in Sweden noted that more than 33% of children who have juvenile onset arthritis see the disease persist into adulthood. They pointed out that other inflammatory diseases such as rheumatoid arthritis have been linked to poor outcomes in pregnancy and hypothesized that a similar link to juvenile onset arthritis may be found.
Because reports of pregnancy outcomes in patients with juvenile onset arthritis are lacking, the authors sought to assess maternal and infant outcomes in women with juvenile onset arthritis and reported their findings in a recent Annals of the Rheumatic Diseases article.
They conducted a population-based cohort study that compared 1807 single childbirths to mothers with a diagnosis of juvenile onset arthritis to 1,949,202 population control births.
• When compared with controls, preterm birth was more common in women with juvenile onset arthritis (juvenile only, 5.9% verses 5.0%).
• Women with juvenile onset arthritis (juvenile only) were at increased risk for moderately preterm delivery and medically indicated preterm birth when compared with controls (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.07-1.91 and OR, 1.74; 95% CI, 1.35-2.67, respectively).
• More juvenile only arthritis births were induced when compared with controls (13.9% versus 10.3%).
• Cesarean delivery was more common in patients with juvenile only arthritis when compared with controls (OR, 1.42; 95% CI, 1.66-1.73).
• In women whose juvenile onset arthritis persisted into adulthood, there was an increased risk of early onset pre-eclampsia (OR, 6.28; 95% CI, 2.86-3.81) and late onset pre-eclampsia (OR, 1.96; 95% CI, 1.31-2.91) compared with controls.
• The risk of moderately preterm and very preterm birth was increased in subjects with persistent juvenile arthritis when compared with controls (OR, 2.74; 95% CI, 1.68-3.08 and OR, 3.14; 95% CI, 1.58-6.24, respectively).
• Subjects with persistent juvenile arthritis were more often induced than controls (OR, 1.37; 95% CI, 1.07-1.75).
• Pre-eclampsia occurred in 22.9 % of patients who had persistent juvenile onset arthritis with preterm labor compared with 12.4% of control subjects.
• Pre-eclampsia occurred in 45.5% of medically indicated preterm birth patients with persistent juvenile onset arthritis compared with 36.6% in the control group.
• 32.1% of medically indicated preterm birth patients with persistent juvenile onset arthritis had small for gestational age infants compared with 14.3% in the control group.
• Diabetes diagnosis did not alter the results.
Implications for physicians
• Patients with a prior diagnosis of juvenile onset arthritis are at increased risk for pregnancy complications, including preterm birth, pre-eclampsia, and small for gestational age infants, when compared with the general population.
• When juvenile onset arthritis persists into adulthood, the risk of pregnancy-related complications is further increased.
• Inductions of labor and cesarean deliveries are more common in patients with juvenile onset arthritis.
• Physicians should be particularly vigilant and prepared for potential complications in patients with former and persistent juvenile onset arthritis.
Support for this project was provided by the Swedish Cancer Society, the Swedish Foundation for Strategic Research, the Stockholm County Council, the Swedish Heart-Lung Foundation, the Swedish research Council, and the Nordic Research Council.
Remaeus K, Johansson K, Askling J, Stephansson O. “Juvenile onset arthritis and pregnancy outcome: a population-based cohort study.” Ann Rheum Dis. 2017 Nov;76(11):1809-1814. doi: 10.1136/annrheumdis-2016-210879. Epub 2017 Jun 29.