Adverse Impact of Rheumatoid Arthritis on Pregnancy Outcomes: A Saudi Arabia Prospective Multicenter Study

Figures & data

Table 5 Binary Logistic Regression Using Backward Selection for Assessing the Relation Between Clinical Variables and RA Pregnancy-Related Outcomes

Parameters	β	S.E.	Wald	p-value	Adjusted Odds Ratio	95% C.I.
Age at pregnancy	0.538	0.604	0.795	0.373	1.713	0.525	5.59
Age of diagnosis	−0.447	0.606	0.543	0.461	0.64	0.195	2.098
Disease Duration	−0.529	0.635	0.695	0.404	0.589	0.17	2.045
Seropositive	−0.393	0.814	0.234	0.629	0.675	0.137	3.324
Smoker	−0.129	1.794	0.005	0.943	0.879	0.026	29.586
ESR	−0.017	0.04	0.183	0.669	0.983	0.909	1.063
CRP	0.023	0.043	0.289	0.591	1.023	0.941	1.114
bDMARDs	−1.705	0.916	3.463	0.063	0.182	0.03	1.095
Prednisolone	−1.41	1.183	1.422	0.233	0.244	0.024	2.478
csDMARDs	−1.176	0.9	1.706	0.191	0.309	0.053	1.801
DAS28-CRP (Mild)	2.437	1.004	5.888	0.015*	11.44	1.598	81.903
DAS28-CRP (Moderate-Severe)	4.608	1.779	6.713	0.001*	100.308	3.072	3275.802

Note: *Statistically significant.

Table 1 Demographics and Clinical Data of Rheumatoid Arthritis Patients

RA Group (n = 77)	Data
Age at pregnancy^¥, mean ± SEM, years	32.78 ± 0.69^¥
Age of disease onset^¥, mean ± SEM, years	26.49 ± 0.82^¥
Duration of disease^¥, mean ± SEM, years	9.16 ± 0.55^¥
RF-CCP Status, n (%)^¥
Seropositive	47 (61.04%)
Smoking (yes), n (%)	5 (6.49%)
Planned pregnancies of RA patients, n (%)	63 (81.8%)
DMARDs used during pregnancy
Patients without medication n (%)	23 (29.87%)
Patients with steroid monotherapy or csDMARDs and steroids n (%)	33 (42.86%)
Patients were on bDMARDs n (%)	21 (27.27%)
ESR before conception^¥, mean ± SEM	18.12 ± 2.33^¥
CRP before conception^¥, mean ± SEM	11.28 ± 1.90^¥

Note: ^¥Valid n is given.

Abbreviations: SEM, standard error of the mean; RA, rheumatoid arthritis; RF-CCP, rheumatoid factor-cyclic citrullinated peptide; ESR, erythrocyte sedimentation rate, CRP, C-reactive protein; DMARDs, disease modifying antirheumatic drugs.

Table 2 Comparison Between RA Group and Healthy Controls Groups

Parameters	Pregnancy Cases with RA (n = 77)	Pregnancy Cases as Healthy Controls (n = 250)	p-value
Age at pregnancy, mean ± SEM, years	32.78 ± 0.69^¥	30.32 ± 0.84	0.034*
Neonatal outcomes
Newborn weight, mean ± SEM, gm	2701.50 ± 87.39^¥	3044.09 ± 47.14	0.001*
Congenital anomalies, n (%)^¥	1 (1.3)	4 (1.6)	0.849
Stillbirth, n (%)^¥	1 (1.3)	3 (1.2)	0.944
Preterm birth, n (%)^¥	17 (22.1)	21 (8.4)	0.001*
NICU admission, n (%)^¥	3 (3.9)	0 (0.0)	0.001*
Pregnancy related
Preeclampsia, n (%)^¥	0 (0.0)	1 (0.4)	0.651
C-section, n (%)^¥	8 (10.39)	17 (6.8)	0.298
Abortions, n (%)^¥	8 (10.4)	15 (6.0)	0.18
Ectopic pregnancy, n (%)^¥	0 (0.0)	2 (0.8)	0.429

Notes: *Statistically significant at the 5% level of significance; ^¥valid n is given.

Abbreviations: SEM, standard error of the mean; RA, rheumatoid arthritis; NICU, neonatal intensive care unit; C-section, cesarean-section.

Figure 1 Comparison of DAS28-CRP before conception, during pregnancy (between 3–6 months and at 9 months), and post pregnancy.

Table 3 The Relation Between Clinical Variables and RA Pregnancy-Related Outcomes

Parameters	Total Adverse Pregnancy Outcomes (n = 27)	Abortion (n = 8)	Preterm (n = 17)	Stillbirth (n = 1)	NICU Admission (from Preterm) (n = 3)	p-value
Disease duration, mean ± SEM, years	6.07 ± 0.68	5.75 ± 1.7	6.41 ± 0.76	5.0 ± 0.0	9.67 ± 0.88^†	<0.001*
Age at pregnancy, mean ± SEM, years	32.85 ± 1.01	34.25 ± 2.3	32.53 ± 1.10	25.0 ± 0.0^†	31.67 ± 5.23	0.003*
ESR, mean ± SEM	27.74 ± 3.62	25.6 ± 6.9	30.12 ± 4.70	21.0 ± 0.0	53.67 ± 2.33^†	<0.001*
CRP, mean ± SEM	13.0 ± 2.61	18.25 ± 5.6	11.41 ± 3.15	6.0 ± 0.0	24.78 ± 14.32^†	0.001*

Notes: *Statistically significant at the 5% level of significance; ^†significant difference with others.

Abbreviations: SEM, standard error of the mean; RA, rheumatoid arthritis; NICU, neonatal intensive care unit; ESR, erythrocyte sedimentation rate, CRP, C-reactive protein.

Table 4 Association Between Smoking, Medications Used During Pregnancy and Disease Activity Scoring at Conception and RA Pregnancy-Related Outcomes

Clinical Parameters	Adverse Pregnancy Outcome
	Preterm N=17 n (%)		NICU Admission (from Preterm) N=3 n (%)		Abortion N=8 n (%)		Stillbirth N=1 n (%)
	No	Yes	No	Yes	No	Yes	No	Yes
Smoker
No	47 (75.8)	15 (24.2)	60 (96.8)	2 (3.20)	55 (88.7)	7 (11.3)	61 (98.4)	1 (1.60)
Yes	3 (60.0)	2 (40.0)	4 (80.0)	1 (20.0)	4 (80.0)	1 (20.0)	5 (100.0)	0 (0.00)
p-value	0.595		0.211		0.482		0.775
bDMARDs
No	30 (69.8)	13 (30.2)	41 (95.3)	2 (4.70)	38 (88.4)	5 (11.6)	42 (97.7)	1 (2.3)
Yes	20 (83.3)	4 (16.70)	23 (95.8)	1 (4.20)	21 (87.5)	3 (12.5)	24 (100)	0 (0.00)
p-value	0.221		0.927		0.916		0.452
Prednisolone
No	43 (78.2)	12 (21.8)	54 (98.2)	1 (1.80)	48 (87.3)	7 (12.7)	54 (98.2)	1 (1.8)
Yes	7 (58.3)	5 (41.7)	10 (83.3)	2 (16.7)	11 (91.7)	1 (8.3)	12 (100)	0 (0.00)
p-value	0.164		0.080		0.671		0.638
csDMARDs
No	29 (69.0)	13 (31.0)	41 (97.6)	1 (2.40)	39 (92.9)	3 (7.1)	41 (97.6)	1 (2.4)
Yes	21 (84.0)	4 (16.0)	23 (92.0)	2 (8.00)	20 (80.0)	5 (20.0)	25 (100)	0 (0.00)
p-value	0.174		0.551		0.138		0.437
DAS28-CRP
Remission	35 (83.3)	7 (16.7)	42 (100)	0 (0.0)	40 (95.2)	2 (4.80)	42 (100)	0 (0.0)
Mild	10 (83.3)	2 (16.7)	12 (100)	0 (0.0)	9 (75.0)	3 (25.0)	11 (91.7)	1 (8.3)
Moderate-Severe	5 (38.5)	8 (61.5)	10 (76.9)	3 (23.1)	10 (76.9)	3 (23.1)	13 (100)	0 (0.0)
p-value	0.006*		0.011*		0.030*		0.179

Note: *Statistically significant.