Evaluation of pregnancy outcomes in patients with rheumatoid arthritis compared with the general population: results from a French national prospective and matched study

Objectives The aim of the study was to assess the contemporary frequency of adverse pregnancy outcomes in women with rheumatoid arthritis (RA) and to identify associated factors. Methods This French prospective multicentre cohort included pregnant women with RA between 2015 and 2021. Maternal characteristics, disease activity, treatments and pregnancy outcomes were analysed. Outcomes of pregnancies in women with RA were compared in univariable analysis with those of matched general population women from the 2016 and 2021 French perinatal surveys assessing maternal and neonatal health. Multivariable logistic regressions were performed to identify factors associated with adverse outcomes. Results A total of 100 pregnancies in 90 women with RA were analysed. Mean maternal age was 33.7±5.0 years and 57.6% were nulliparous. During pregnancy, 46% received glucocorticoids and 39% biologic disease-modifying antirheumatic drugs. Compared with the 359 controls from the general population, preterm birth (OR 2.08, 95% CI 1.04 to 4.09) and small for gestational age (SGA) (OR SGA 10th percentile 2.11, 95% CI 1.12 to 3.94; OR SGA 3rd percentile 3.21, 95% CI 1.13 to 9.44) rates were higher in RA pregnancies. SGA was associated with nulliparity (adjusted OR (aOR) 4.38, 95% CI 1.12 to 9.78), whereas preterm birth was associated with maternal age (aOR 1.14, 95% CI 1.01 to 1.30) and exposure to glucocorticoids at doses ≥10 mg/day during pregnancy (aOR 4.91, 95% CI 1.30 to 10.59). Conclusion In this contemporary cohort mostly followed in tertiary care centres, pregnancies in women with RA remained at increased risk of preterm birth and SGA. Exposure to systemic glucocorticoids at doses ≥10 mg/day emerged as a risk factor for preterm birth, although a contribution of maternal disease activity cannot be entirely excluded.