title: Disease Severity and Pregnancy Outcomes in Women with Rheumatoid Arthritis: Results from the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project.
abstract: OBJECTIVE
  To determine the effect of rheumatoid arthritis (RA) disease severity on pregnancy outcomes in pregnant women with and without autoimmune diseases.
  
  
  METHODS
  A prospective cohort study was conducted using the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project. Pregnant women with RA enrolled between 2005 and 2013 were selected if they (1) delivered a live-born singleton infant; and (2) completed 3 telephone-based measures of RA disease severity prior to 20 weeks' gestation, including the Health Assessment Questionnaire Disability Index (HAQ-DI), pain score, and patient's global scale. Associations between RA disease severity and preterm delivery, small for gestational age (SGA), or cesarean delivery were tested in unadjusted and multivariate analyses using modified Poisson regression models.
  
  
  RESULTS
  The sample consisted of 440 women with RA. Several unadjusted comparisons yielded significant associations. After adjustment for covariates, increasing disease severity was associated with risk for preterm delivery and SGA. For each unit increase in HAQ-DI (0-1), the adjusted relative risk (aRR) for preterm delivery increased by 58% (aRR 1.58, 95% CI 1.17-2.15). Among those with HAQ-DI > 0.5, the aRR for SGA was 1.81 (95% CI 1.01-3.33).
  
  
  CONCLUSIONS
  RA disease severity in early pregnancy, as measured in this study, was predictive of preterm delivery and SGA. These findings suggest that the risk of preterm delivery and SGA in women with RA might be lowered if RA is well controlled early in pregnancy.
authors: From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego. bbharti@ucsd.edu.
authors: Balambal
authors: B
authors: Bharti
authors: From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego.
authors: Susan J
authors: SJ
authors: Lee
authors: From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego.
authors: Suzanne P
authors: SP
authors: Lindsay
authors: From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego.
authors: Deborah L
authors: DL
authors: Wingard
authors: From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego.
authors: Kenneth L
authors: KL
authors: Jones
authors: From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego.
authors: Hector
authors: H
authors: Lemus
authors: From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego.
authors: Christina D
authors: CD
authors: Chambers
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: DISEASE SEVERITY; PREGNANCY OUTCOMES; RHEUMATOID ARTHRITIS