Adverse Impact of Rheumatoid Arthritis on Pregnancy Outcomes: A Saudi Arabia Prospective Multicenter Study

Hanan Al Rayes,1 Sultana Abdulaziz,2 Asma Mohammed Alotaibi,3 Mufaddal Adil Alaithan,1 Mohammed Attar,4 Hassan Daghasi,4 Rand Melibari,2 Ali H Althagafi,4 Basant Elnady4,5 1Rheumatology Division, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 2Division of Rheumatology, Department of Medicine, King Fahad Hospital, Jeddah, Saudi Arabia; 3Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 4Division of Rheumatology, Department of Medicine, Al Hada Armed Forces Hospital, Taif, Saudi Arabia; 5Rheumatology, Rehabilitation and Physical Medicine Department, Faculty of Medicine, Benha University, Benha, EgyptCorrespondence: Basant ElnadyDivision of Rheumatology, Department of Medicine, Al Hada Armed Forces Hospital, Al Hada Ring Road, Al Hada, Postal Code 1347, Taif, Zip Code 21944, Saudi ArabiaTel +966562387723Fax +966127542811Email [email protected]: Rheumatoid arthritis (RA) is associated with adverse pregnancy outcomes and postpartum complications, especially with severe disease activity.Objective: The current study aimed to compare the pregnancy outcomes in patients with RA and healthy controls as well as to assess the impact of disease-related variables, medications and disease activity on pregnancy and neonatal-related outcomes in the Saudi population.Methods: This prospective multicenter study included pregnant female patients with RA from three tertiary centers in Saudi Arabia. The demographics, disease activity scoring (DAS28-CRP), medication before and during pregnancy, pregnancy-related outcomes, and complications in comparison to age-matched healthy female controls were noted.Results: A total of 77 pregnant patients with RA and 250 healthy age-matched pregnant controls were included in the study. A total of 67.53% were in remission before conception (DAS28CRP ≤ 2.6), and 81.8% of pregnancies were planned. Age of conception, preterm labor, neonatal intensive care unit (NICU) admission and low birth weight were statistically significant (p < 0.05) and higher in RA patients than in healthy controls. Longer disease duration (p < 0.001), and high C-reactive protein and erythrocyte sedimentation rate levels before conception (p ≤ 0.001) were statistically associated with preterm NICU admission. There was statistically significant association between mild (p = 0.015) or moderate to severe DAS28-CRP (p = 0.001) and RA patients regarding pregnancy outcomes. The classification table obtained from the logistic model showed patients with mild and moderate-severe DAS28-CRP have significantly high chances of having an adverse pregnancy outcome.Conclusion: RA has a negative impact on pregnancy-related outcomes. Higher disease activity is considered a major risk; thus, tight disease control should be aimed. Planned pregnancy follow-up is associated with better pregnancy outcomes.Keywords: rheumatoid arthritis, pregnancy, disease activit

Adverse Impact of Systemic Lupus Erythematosus on Pregnancy Outcomes: A Saudi Arabia Retrospective Multi-Center Study

Hanan Al Rayes,1 Norah AlOudah,1 Roaa Alsolaimani,2,3 Abdulrahman Alharthi,4 Mohammed Attar,4 Hassan Daghasi,4 Abdurahman Albeity,2 Afnan M Afifi,2 Abdulelah AlQahtani,1 Alya Alkaff,5 Sultan M Alkhamesi,3 Basant Elnady4,6 1Department of Rheumatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 2Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 3Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Rheumatology, Al Hada Armed Forces Hospital, Taif, Saudi Arabia; 5Obstetrics and Gynecology Department, King Faisal Specialist Hospital, and Research Center, Jeddah, Saudi Arabia; 6Rheumatology and Rehabilitation Department, Faculty of Medicine, Benha University, Benha, EgyptCorrespondence: Basant Elnady, Tel +966562387723, Email [email protected]: The current study aimed to determine the pregnancy outcomes complications in patients with SLE and its association with clinical, laboratory variables, disease activity, and medication use in the Saudi population, as well as pregnancy effect on disease activity.Methods: A multicenter study included pregnant female patients with Systemic Lupus Erythematosus (SLE) from three tertiary centers in Saudi Arabia. The demographics, clinical, and laboratory variables, SLE disease activity index (SLEDAI), medication before, during, and after pregnancy, planned pregnancy, pregnancy-related outcomes, and complications in comparison to age-matched healthy female controls were noted.Results: A total of 66 pregnant patients with SLE and 93 healthy age-matched pregnant controls were included in the study. A total of 77.3% had SLEDAI-2K ≤ 4 before conception, and 84.85% of pregnancies were planned. Age of conception, cesarean section, miscarriage, and low birth weight were statistically significant (p 4 and active lupus nephritis during pregnancy were statistically associated with adverse outcomes (p 4 was an independent risk at least 4.87 times higher association with adverse pregnancy outcomes. (p < 0.05).Conclusion: SLE is intricately connected with unfavorable pregnancy outcomes. The preconception of high disease activity stands as a pivotal risk factor for adverse outcomes. Despite the disease remission and meticulous planning, SLE patients frequently grapple with disease exacerbations during pregnancy, culminating in unexpected and unfavorable pregnancy-related outcomes. This underscores the intricate and multifaceted nature of managing SLE during gestation.Keywords: systemic lupus erythematosus, pregnancy, disease activit