Autoimmune Diseases in Pregnancy Studies

Rheumatoid Arthritis

Rheumatoid Arthritis Study

Arthritis is a term that refers to inflammation (swelling, pain, and redness) in the joints. Rheumatoid arthritis (RA) is one type of arthritis that can sometimes affect other body systems. RA is the most common type of arthritis that is triggered by the immune system, although the exact cause or causes are not known. The severity of RA can vary from person to person. Many individuals with RA have ongoing milder symptoms with shorter periods of more severe symptoms (flares). RA can occur in both men and women, but it is more common in women.

Dr. Eliza Chakravarty is an Assistant Professor of Medicine (Immunology & Rheumatology) at the Stanford University Medical Center

Dr. Eliza Chakravarty is an Assistant Professor of Medicine (Immunology & Rheumatology) at the Stanford University Medical Center

In the United States, 1.4% of women (or 1 in 71) currently have RA, with most women experiencing their first symptoms in their 50s (Gabriel 1999). However, recent nationwide estimates suggest that about 1,000-2,000 women with RA become pregnant each year. Since most people with RA require medicine to control inflammation and prevent or reduce damage to the joints, it is important for women with RA who are planning a pregnancy or have learned they are pregnant to speak with their doctors about medication and treatment options.

There have been suggestions that RA may lower a woman’s chance to become pregnant. However, it is not known whether this is because of RA or simply because women with RA have waited longer before attempting pregnancy or chosen to have smaller families (Katz 2006). Many women with RA will have some improvement in symptoms during pregnancy, but most will experience an increase in symptoms within four months of delivery. The majority of early studies of the disease activity in RA during pregnancy found RA improved in at least 75% of women, although newer estimates are lower (deMan et al., 2008). Improvements are often seen as early as the first trimester of pregnancy and continue through the end of pregnancy. While this is encouraging, it still leaves at least 25% of women who will not improve during pregnancy. Doctors are not able to predict for any one woman whether her symptoms will improve, stay the same, or worsen during pregnancy.

There are limited studies on pregnancy outcomes of women with RA. Also, the studies themselves are limited in that they cannot tell what is due directly to RA, what is due to the severity of RA, what is due to the medicines, or a combination of all these factors. RA during pregnancy does not appear to be associated with miscarriage, but is associated with higher rates of pregnancy complications, including premature delivery and C-sections (Reed 2006). Another study found that infants born to mothers with RA had slightly lower birth weights (although generally within the normal range), and that the lower birth weights were associated with increased disease activity of RA during pregnancy (deMan et al. 2009). Therefore, a discussion of RA in pregnancy should include any concerns with how RA medicines and disease activity can possibly impact the pregnancy.

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