Fetal Programming in Rheumatoid Arthritis

__Abstract__ Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory, autoimmune disease mainly affecting synovial tissues, which can lead to severe morbidity and progressive joint destruction resulting in deformations and disability. Other important outcomes include extra-articular features and comorbidities, like vasculitis, cardiac disease and infections. RA affects approximately 1% of the adult population and each year, 5 to 50 per 100.000 persons develop this condition. Women are affected two to three times more often than men. The age of onset in women is usually between 40 and 50 years, but it often affects women of childbearing age

Does prednisone use or disease activity in pregnant women with rheumatoid arthritis influence the body composition of their offspring?

Glucocorticoids are given during pregnancy when rheumatoid arthritis (RA) is too active. It could lead to increased risk of cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM) in the offspring. Elevated RA disease activity during pregnancy is associated with low birth weight and rapid post-natal growth. Both can negatively influence the body composition later in life. This study shows that prednisone use or RA disease activity in pregnant women with RA had no influence on the body composition of prepubertal offspring. Furthermore, no components of the metabolic syndrome (MetS) were present in the children, which minimalize the change on CVD or T2DM later in life. This reassuring conclusion might lead to a different therapeutic view when glucocorticoid treatment during pregnancy is inevitable

Low carriage rate of group B streptococcus in pregnant women in Maputo, Mozambique

The prevalence of group B streptococcus (GBS) carriage varies strongly with geographical region. A study was done to determine the prevalence of GBS in women in Maputo, Mozambique. The method used was a rectovaginal swab which was taken from women between 35 and 37 weeks of pregnancy who visited the clinic for antenatal consultation. GBS was cultured from 2 out of 113 samples, yielding a prevalence of 1.8% (95% Cl: 0.0-4.0). In conclusion, the prevalence of GBS carriage among pregnant women in Maputo, Mozambique was low

Does prednisone use in pregnant women with rheumatoid arthritis induce insulin resistance in the offspring?

Objectives The use of long-term corticosteroids during pregnancy has been growing over the past decades. Corticosteroids can be given when an auto-inflammatory disease like rheumatoid arthritis (RA) is too active. Several studies have shown that long-term corticosteroids use in pregnancy is associated with maternal and fetal adverse outcomes, like preeclampsia, shorter gestational age, lower birth weight, and rapid catch-up growth. These last two outcomes could influence the insulin resistance later in life. Our objective was to investigate whether prednisone use in pregnant women with RA induces insulin resistance in offspring. Methods One hundred three children were included after their mother had participated in a prospective cohort study on RA and pregnancy. Forty-two children were in utero exposed to prednisone and 61 were non-exposed. To assess insulin resistance, we measured homeostasis model of assessment insulin resistance (HOMA-IR) and serum adiponectin and lipid levels, corrected for body fat distribution. Results An average of 6 mg prednisone on a daily use gave no difference in mean HOMA-IR (SD) between the children who were prednisone-exposed in utero (1.10 (0.84)) and those non-exposed (1.09 (0.49)). No difference was found in mean adiponectin level, body fat distribution, or lipid levels such as total cholesterol, fasting triglyceride, or high-density lipoprotein. Conclusion Children who are prednisone-exposed in utero (low dose) have no increased risk for insulin resistance at the age of approximately 7 years. These findings are reassuring because the prednisone use during pregnancy is increasing worldwide. Further research has to be performed to evaluate if the insulin resistance remains absent in the future

Circulating maternal cytokines influence fetal growth in pregnant women with rheumatoid arthritis

Background High rheumatoid arthritis (RA) disease activity during pregnancy is associated with a lower birth weight. Active RA is characterised by high circulating levels of cytokines, which can mediate placental growth and remodelling. Objectives To assess the influence of maternal serum cytokine levels on birth weight in RA pregnancy. Methods This study is embedded in the PARA Study, a prospective study on RA and pregnancy. In the present study, 161 pregnant women with RA and 32 healthy pregnant women were studied. The main outcome measures were birth weight SD score (birth weight SDS) in relation to maternal serum levels of interleukin-10 (IL10), interleukin-6 (IL-6) and tumour necrosis factor-α (TNFα) at three different time points: preconception and during the first and third trimester. Single-nucleotide polymorphisms (SNPs) in the corresponding cytokine genes were also studied. Results During the first trimester, IL-10 was detectable in 16% of patients wi