Peripartum Outcomes and Safe Disease-Specific Medication Use Remain Suboptimal in Women with Immune-Mediated Inflammatory Diseases Article Swipe
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· 2025
· Open Access
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· DOI: https://doi.org/10.3899/jrheum.2025-0314.workshop3e_04
· OA: W4411885236
Objectives Observational and population levels studies confirm that immune-mediated inflammatory diseases (IMIDs) including rheumatoid (RA) and psoriatic (PsA) arthritis, spondyloarthritis (SpA) and systemic lupus erythematous (SLE) can negatively affect maternal and neonatal outcomes by way of disease activity and peripartum treatment choices. We hypothesize that despite increased availability of safe peripartum disease treatments for IMID, outcomes are still worse, and treatments underutilized compared to those without IMID in a contemporary Albertan pregnancy cohort. Methods A contemporary pregnancy cohort of 446,017 women and corresponding birth events was assembled for the province of Alberta from the random selection of 1 live birth event per woman. We identified 5 groups: (1) no IMID (n=728,102), (2) RA (n=2,170), (3) PsA (n=103), (4) SpA (n=312) and (5) SLE (n=393). We compared maternal and neonatal outcomes, comorbid conditions and medication use at any point in the pregnancies among the 5 groups. Results Pregnant women with SLE were more likely to have preterm delivery (13.7%), “small for gestational age” babies (19.3%), and NICU admissions (18.6%), compared to the other IMIDs (Table 1). Cesarean section deliveries were highest in women with SLE (35.9%) and RA (34.7%) while women with SpA had more induction (37.8%) compared to the other groups. The PsA group had the highest corticosteroid (17.5%) and biologic use (16.5%) in the peripartum period while it was lower in RA (8.7%) patients. Antimalarial use was highest in women with SLE (25.4%) and did not decrease when broken down when assessed per trimester. Table 1. Maternal Characteristics, Peripartum Outcomes and Medication Use Conclusion Worse peripartum outcomes are higher among women with SLE and RA compared to women with PsA, AS or no IMID although specific findings including more inductions in SpA patients is notable. Medications are safe in pregnancy (eg, antimalarials and certain biologics) have low uptake which may influence these outcomes. Further peripartum studies evaluating drug safety and outcomes are needed with assessment of the contributions of disease activity. Supported by a CIORA grant
