Maternal and neonatal outcomes in pregnancies with rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis: a comparative study.

Background: Chronic inflammatory arthritis, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthritis (SpA), poses unique challenges during pregnancy due to potential maternal and fetal complications. This study aimed to compare pregnancy outcomes among women with these conditions in Qatar.

Methods: A retrospective cohort study was conducted at Hamad General Hospital from 2016 to 2022. Data on sociodemographic characteristics, disease features (e.g., disease duration, serological markers), treatments, and pregnancy outcomes were extracted from electronic medical records. Pregnancy outcomes included miscarriage, live birth, and intrauterine fetal demise (IUFD); delivery data such as term, weeks of gestation, and mode of delivery; and neonatal data including birth weight, low birth weight (LBW), congenital anomalies, and NICU admissions. Multivariable logistic regression was used to identify associations between disease subtype, medication use, and pregnancy outcomes.

Results: A total of 189 pregnant women were included (RA = 131, SpA = 29, and PsA = 29). Pregnancy outcomes were compared across the three patient groups: SpA was associated with the highest live birth rate (89.7%), while PsA had the highest rate of NICU admissions (13.8%) and lowest preterm birth rate (6.9%). Intrauterine growth restriction (IUGR) occurred only in RA (31%). Multivariable analyses showed that SpA was linked to significantly higher odds of live birth and lower risks of miscarriage, peripartum complications, and low birth weight compared to RA. PsA was associated with a reduced risk of preterm birth. Advanced maternal age increases the risk of any complication taken together. Sulfasalazine use was associated with lower miscarriage risk and higher likelihood of live birth, but also increased NICU admissions, as did anti-TNF therapy. Hydroxychloroquine use was associated with a protective effect against NICU admissions and low birth weight.

Conclusion: Pregnancy outcomes vary significantly across chronic inflammatory arthritis subtypes. Our findings underscore the need for individualized, multidisciplinary care and further prospective studies to guide clinical management.