Study Investigates Reproductive Health Outcomes of Patients With Rheumatic Diseases

Reproductive health outcomes appear to be greatly impacted by the presence of rheumatic diseases, according to a registry study published in Rheumatology.

“Many studies on reproductive health in [immune-mediated diseases (IMDs)] are characterized by small sample sizes, with less systematic data available on unselected patient populations, few comparative studies across different IMDs, and even fewer looking at both women and men,” the authors wrote. They utilized data from a nationwide registry in Finland to assess the impact of IMDs on reproductive success and adverse maternal and perinatal outcomes in men and women born between 1964 and 1984. Participants who were diagnosed with any IMD before age 30 (women) or 35 (men) were matched to 20 controls by birth year, sex, and education level. The number of children was assessed, as well as data on the mother’s age at delivery, pregnancy-related characteristics and outcomes, and the use of child home-care allowance (mean weeks per child).

The results showed that several rheumatic diseases, particularly systemic lupus erythematosus (SLE), juvenile idiopathic arthritis (JIA), and seropositive rheumatoid arthritis (RA), were associated with participants having higher rates of childlessness or fewer children overall for women. “For many of the diseases in which we observed fewer children, fewer pregnancies were also observed,” the authors noted. The ages of having one’s first and last child were earlier for women with rheumatic diseases and other IMDs compared with controls.  Among men, “seropositive RA, SLE, and JIA were characterized by increased prevalence of childlessness and fewer children,” the authors wrote.

The authors noted that most of the rheumatic diseases studied were associated with an increased risk of preeclampsia, newborns being small for gestational age, preterm delivery, nonelective Caesarean section, and need for neonatal intensive care, with particularly high risks for SLE and Sjögren syndrome. Of the rheumatic diseases, SLE, JIA, RA, and psoriatic arthritis (PsA) were associated with a greater risk of preeclampsia, and PsA was associated with a high risk of gestational hypertension.

“In most rheumatic diseases, moderate (1.1-1.5-fold) risk increases were observed for diverse adverse pregnancy outcomes, with similar effects in [irritable bowel syndrome], celiac disease, asthma, [immune thrombocytopenic purpura], and psoriasis,” the authors noted. They added that the presence of IMDs did not impact the time of returning to the workforce after having a child.

The study was limited to the use of data from the Finnish population, which limits the generalizability outside of countries with similar health care systems. The authors acknowledged they were unable to control for disease-specific factors, such as autoantibodies and disease activity indices. The study was also limited by the use of administrative data for defining IMDs, which can include errors such as incorrect or unspecific coding. The age criteria may also have missed some pregnancies occurring prior to diagnosis.

In summary, “Reproductive success is preserved in many rheumatic diseases, but SLE, JIA, and seropositive RA were associated with a higher incidence of childlessness in both men and women,” the authors wrote. “Considering the widespread impact of rheumatic diseases on reproductive health, our results emphasize the recommendation to discuss family planning early and often in women of reproductive age who have rheumatic diseases and may aid in forming recommendations for pregnancy monitoring in women with rheumatic diseases.” They called for further research to illuminate the role of IMDs on male reproductive health and predictors of adverse pregnancy outcomes in each IMD.