This does not mean that RA is without impact on pregnancy. Dr. Bermas noted that in a 2006 study of more than 1,400 pregnancies in women with RA compared with 4 million live births in healthy controls, the rates of hypertensive disorders, intrauterine growth restriction, premature rupture of membranes and prenatal hospitalization were all higher among women with RA.3 Women are at increased risk of disease flare following delivery; one study found that close to 40% of patients experienced an RA flare in the post-partum period.2
Complications in Lupus
Systemic lupus erythematosus is perhaps the condition of most interest to rheumatologists with respect to pregnancy complications. Many studies have evaluated the risk of lupus flares in pregnancy, and the results have not revealed a uniform picture. However, several risk factors have been discovered, including active disease at time of conception (as manifested by increased titers of antibodies to dsDNA and/or low complement levels), prior lupus nephritis, primigravida status, pulmonary hypertension, prior history of pre-eclampsia and discontinuation of hydroxychloroquine (HCQ).
The ability to measure HCQ blood levels has allowed for monitoring of adherence to therapy. Of note, a recent study from Dr. Bermas and colleagues indicates the proportion of women initiating HCQ during pregnancy increased from 2001 to 2015, but its overall use in pregnancy remains low.4