Patient-Reported Disease Activity and Adverse Pregnancy Outcomes in Systemic Lupus Erythematosus and Rheumatoid Arthritis

Objective While increased rheumatic disease activity during pregnancy has been associated with adverse pregnancy outcomes, this disease activity is typically assessed by physicians. Little is known, however, about the association between patient-reported measures of disease activity and pregnancy outcomes. The aim of our study was to evaluate this association. Methods Univariate and multivariable regression models were used to assess the relationship between patient- and physician-reported measures of disease activity and adverse pregnancy outcomes in 225 patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). The patients were enrolled from 2008-2016 in a prospective registry at a single academic center. Results In women with RA, patient-reported disease activity was associated with preterm birth (odds ratio [OR] 5.9 [95% confidence interval (95% CI) 1.5, 23.9]) and gestational age in weeks (beta = -1.5 [95% CI -2.6, -0.4]). The physician assessment of disease activity also predicted preterm (OR 2.1 [95% CI 1.2, 3.5]), small for gestational age births (OR 1.8 [95% CI 1.03, 3.1]), and gestational age in weeks (beta = -0.6 [95% CI -0.9, -0.02]). Alternatively, in women with SLE, patient-reported disease activity measures, including the Health Assessment Questionnaire, pain, or global health measures, were not associated with adverse pregnancy outcomes. However, physician measures of SLE disease activity are associated with preterm birth (OR 2.9 [95% CI 1.3, 6.3]), cesarean delivery (OR 2.3 [95% CI 1.0, 5.3]), and preeclampsia (OR 2.8 [95% CI 1.3, 6.3]). The results did not appear to be driven by lupus nephritis or antiphospholipid syndrome. Conclusion For women with RA, patient-reported measures of disease activity were associated with adverse pregnancy outcomes, and thus may be useful adjuncts to physician-reported measures in identifying pregnancies at greater risk. In contrast, in SLE, while physician measures of disease activity helped predict several adverse pregnancy outcomes, no patient-reported measures were associated with adverse outcomes.