Risk of pre-eclampsia and impact of disease activity and anti-rheumatic treatment in women with rheumatoid arthritis, axial spondylarthritis, and psoriatic arthritis – a collaborative matched cohort study from Sweden and Denmark
Authors: Anne Emilie Secher al.
In RA, high disease activity has been associated with adverse pregnancy outcomes. Limited data is available in pregnant PsA patients with regard to the risk of pre-eclampsia. Data from the Rheumatology Danish (DANBIO) and Swedish registries (SRQ) were linked to birth registries and compared to matched controls (2006-2018). 489 PsA pregnancies were analysed and compared to 1739 RA and 819 axSpA pregnancies. Pregnant PsA patients were more likely to be obese, smoking and less educated compared to controls. An overall increased risk of pre-eclampsia was observed in PsA (5.3%, adjusted OR 1.85 (1.10, 3.12), but not in RA and axSpA pregnancies. Monotherapy with a bDMARD, csDMARD or steroids was associated with an increased pre-eclampsia risk in PsA (adjusted OR 2.71 (1.43, 5.12) but not in RA or axSpA. High disease activity was associated with an increased pre-eclampsia risk in RA, but not in PsA or axSpA.
Limited data is available regarding pregnancy outcomes in PsA patients. This study compares the risk of pre-eclampsia in PsA patients versus women with RA or axSpA and demonstrates that the overall risk for pre-eclampsia is increased in PsA patients and associated to treatment with csDMARDs, bDMARDs or steroids in monotherapy. However, this association may indicate a higher risk of pre-eclampsia in PsA patients with more severe disease. Nevertheless, consultation of women with PsA who plan to become pregnant should focus on optimizing other factors including cessation of smoking as well as weight and blood pressure control.