Risk Factors of Adverse Pregnancy Outcome in Romanian Rheumatoid Arthritis Patients

Background Rheumatoid arthritis could be considered risk factor for adverse pregnancy outcome. Objectives The definition of adverse pregnancy outcome includes spontaneous abortion, prematurity, small new-borns for gestational age or with intrauterine growth restriction. The main purpose of this study was to identify the risk factors for adverse pregnancy outcome in a national multicentric cohort of Romanian females diagnosed with Rheumatoid Arthritis before pregnancy. Methods Our analysis totalized 96 pregnancies followed between 2012-2017 retrospectively (72) or prospectively (24). Excluding the elective abortions (15) and ongoing pregnancies (3), the adverse outcome was noticed in 37 situations, while in the 41 left the result was considered good pregnancy outcome (birth at term with normal weight for gestational age). For the statistical validation of the acquired risk factor for adverse pregnancy outcome were used chi square test and binary logistic regression (IBM SPSS). Results Out of 37 pregnancies with adverse outcome, 24 finished with spontaneous abortions (23-first trimester of pregnancy, 1 second trimester), 7 cases with prematurity, 4 children were considered small for gestational age and 4 with intrauterine growth restriction. For prematurity was relevant the conceptual mother age, more than 35 years old, OR=7.619, [IC] 95%: 1.394-1.41.653. Regarding the deficitary growth chart (8 pregnancies), this issue was associated with active disease during first trimester (p=0.031), neither was associated with corticotherapy or TNF blockers use during pregnancy. The unplanned pregnancies and respectively the thrombophilia were the most common risk factors associated with adverse outcome, OR=5.630 [IC] 95%: 1.651-19.2016 respectively OR=5.486, [IC] 95%: 1.756-17.141. The active disease during the third trimester of pregnancy were not related to adverse pregnancy outcome (p=0.864). Conclusions Females diagnosed with Rheumatoid Arthritis, which intend to plan a pregnancy need to know that the remission or low disease activity at preconception, non-smoker status and non-invalidated disease could reduce the risk of pregnancy complications.