Association between pregnant women with rheumatoid arthritis and preeclampsia: A systematic review and meta-analysis

Cardiovascular Complications During Delivery Hospitalization in Patients With Psoriasis

BACKGROUND

Psoriasis in pregnancy is associated with adverse maternal outcomes. However, there are limited data on this subject.

OBJECTIVES

The purpose of our study was to investigate the association between psoriasis and related cardiovascular complications during delivery.

METHODS

The National Inpatient Sample was used to identify hospitalizations for delivery from 2011 to 2020. Propensity score matching was performed to study the association of psoriasis with the primary outcomes of in-hospital medical and obstetric complications.

RESULTS

A total of 37,482,206 weighted delivery hospitalizations in women ≥18 years were identified; of which, 23,588 patients had psoriasis. Pregnant patients with psoriasis had a higher incidence of complications during delivery, including preeclampsia/eclampsia, acute kidney injury, pulmonary edema, cardiac arrhythmias, and venous thromboembolism compared to those without psoriasis. In propensity-matched analysis, psoriasis was significantly associated with a higher risk of preeclampsia/eclampsia (OR: 1.25, 95% CI: 1.08 to 1.43, P = 0.002) and cardiac arrhythmias (OR: 1.44, 95% CI: 1.08-1.93, P = 0.012), compared to patients without psoriasis.

CONCLUSIONS

Delivery hospitalizations in patients with psoriasis are associated with a higher risk of preeclampsia/eclampsia and cardiac arrhythmias.

Causal Association of Rheumatoid Arthritis With Adverse Pregnancy Outcomes: Genetic Evidence From Mendelian Randomization

OBJECTIVE

Although the association of rheumatoid arthritis (RA) to multiple adverse pregnancy outcomes has been well-studied, the association between serum antibody levels in patients with RA and multiple adverse pregnancy outcomes has not been conclusively demonstrated. Here, we comprehensively assessed the causal impact of RA, serologic antibody-positive RA (pRA), and serologic antibody-negative RA (nRA) on the risk of 14 adverse pregnancy outcomes.

METHODS

The causal impact of RA, pRA, and nRA on 14 adverse pregnancy outcomes was comprehensively assessed using two-sample Mendelian randomization (MR). Evidence maps based on the results of these two-sample MR analyses were developed. Data from the UK Biobank and FinnGen databases were utilized for this analysis. The inverse variance weighted (IVW) test was employed as the primary method to estimate causality. "TwoSampleMR" and "MR-PRESSO" packages were used for data analysis in this study.

RESULTS

Using two-sample MR analysis, we found a significant positive causal association between RA and increased risk of cesarean section (p = 0.003), gestational hypertension (p < 0.001), number of spontaneous miscarriages (p = 0.041), preeclampsia (p = 0.008), premature rupture of membranes (p = 0.030), and preterm (p = 0.010). pRA had a significant positive causal association with an increased risk of cesarean section (p = 0.012), gestational hypertension (p < 0.001), preeclampsia (p = 0.002), and preterm (p = 0.007). A significant positive causal association was also established between nRA and gestational hypertension (p = 0.010), the number of spontaneous miscarriages (p = 0.024), and placental abruption (p = 0.027). In addition, we found a causal association between nRA and birth weight (p = 0.007), but not between RA and pRA and birth weight.

CONCLUSION

The results of this study have important implications for the individualized treatment of RA patients, especially those with positive serum antibody levels.

Rheumatoid Arthritis and Pregnancy: Managing Disease Activity and Fertility Concerns

Rheumatoid arthritis (RA) is a systemic autoimmune disease that more commonly affects women, including many women during the childbearing years. This can make management challenging for practitioners involved in the care of these patients. This review article will discuss the available data and expert recommendations pertaining to women with RA who are pregnant or planning pregnancy. Herein, we will consider pregnancy complications associated with RA, the benefits of maintaining low disease activity prior to conception and throughout pregnancy, flare management during pregnancy, ensuring pregnancy-compatible medications to treat RA, and the reduced rates of fertility in patients with RA. While research in this area has greatly expanded over the past decade, it continues to be an area where more research is needed to best support women with RA as they navigate pregnancy.

Autoimmune diseases and adverse pregnancy outcomes: an umbrella review

BACKGROUND

There is a high prevalence of autoimmune conditions in women specially in the reproductive years; thus, the association with adverse pregnancy outcomes has been widely studied. However, few autoimmune conditions/adverse outcomes have been studied more than others, and this umbrella review aims to consolidate existing knowledge in this area with the aim to provide new knowledge and also identify gaps in this research area.

METHODS

Medline, Embase, and Cochrane databases were searched from inception to December 2023. Screening, data extraction, and quality appraisal (AMSTAR 2) were done by two independent reviewers. Data were synthesised narratively and quantitatively. Relative risks (RR)/odds ratio (OR) with 95% confidence intervals were reported.

RESULTS

Thirty-two reviews were included consisting of 709 primary studies. The review reported the association between 12 autoimmune conditions and 16 adverse pregnancy outcomes. Higher risk of miscarriage is reported in women with Sjögren's syndrome RR 8.85 (95% CI 3.10-25.26) and systemic lupus erythematosus (SLE) OR 4.90 (3.10-7.69). Pre-eclampsia was reported higher in women with type 1 diabetes mellitus (T1DM) OR 4.19 (3.08-5.71) and SLE OR 3.20 (2.54-4.20). Women reported higher risk of diabetes during pregnancy with inflammatory bowel disease (IBD) OR 2.96 (1.47-5.98). There was an increased risk of intrauterine growth restriction in women with systemic sclerosis OR 3.20 (2.21-4.53) and coeliac disease OR 1.71 (1.36-2.14). Preterm birth was associated with T1DM OR 4.36 (3.72-5.12) and SLE OR 2.79 (2.07-3.77). Low birth weight babies were reported in women with women with SLE or systemic sclerosis OR 5.95 (4.54-7.80) and OR 3.80 (2.16-6.56), respectively. There was a higher risk of stillbirth in women with T1DM OR 3.97 (3.44-4.58), IBD OR 1.57 (1.03-2.38), and coeliac disease OR 1.57 (1.17-2.10). T1DM in women was associated with 32% lower odds of small for gestational age baby OR 0.68 (0.56-0.83).

CONCLUSIONS

Pregnant women with autoimmune conditions are at a greater risk of developing adverse pregnancy outcomes. Further research is required to develop better preconception to postnatal care for women with autoimmune conditions.