THU0675 The impact of autoimmune rheumatic diseases on birth outcomes in an ethnically diverse cohort of women in the united states
Authors: J.L. Strouse, B.M. Donovan, M. Fatima, R. Fernandez-Ruiz, L. Jelliffe-Pawlowski, R.J. Baer, C. Smith, G. Bandoli, R. Paynter, N. Parikh, K. Ryckman, N. Singh
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Autoimmune rheumatic diseases (ARDs) often affect women of childbearing age and have been associated with adverse pregnancy outcomes. Most of the literature on the impact of ARDs on birth outcomes to date has focused on the burden of common ARDs (e.g., rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)) within Caucasian populations. The effect of race/ethnicity on birth outcomes among women with ARDs is not well understood. Identification of groups who are at highest risk of adverse birth outcomes may aid in increased prenatal surveillance and prevention of maternal and fetal morbidity. <h3>Objectives</h3> To evaluate the impact of ARD on adverse birth outcomes, specifically preterm birth (PTB), congenital anomalies, and low birth weight (LBW), in a large, ethnically diverse cohort. <h3>Methods</h3> We conducted a matched cohort analysis of retrospective data from all singleton live births in California occurring between 2007 and 2012. Data on ARD diagnosis, including RA, SLE, antiphospholipid syndrome (APS), psoriatic arthritis (PsA), ankylosing spondylitis (AS), or juvenile idiopathic arthritis (JIA), and birth outcomes were derived from birth certificate records linked to hospital/discharge ICD9 codes present anytime at or one year prior to delivery. Women without any of the previously mentioned rheumatic diseases were age- and ethnicity-matched in 2:1 ratio to women with ARD; their characteristics were compared using conditional logistic regression. We also examined the association between specific ARD diagnoses and birth outcomes stratified by race/ethnicity. <h3>Results</h3> We identified 10 975 women with a recorded ARD diagnosis (RA: 3129 (26%), SLE: 3863 (33%), APS: 4180 (35%), PsA: 173 (2%), AS: 144 (1%), and JIA: 354 (3%)). The odds of PTB were increased for women with any ARD (aOR 1.90 (95% CI 1.76–2.05)) and among those with RA (aOR 1.65 (95% CI 1.47–1.85)), SLE (aOR 2.25 (95% CI 2.05–2.47)), APS (aOR 1.82 (95% CI 1.64–2.01)), and JIA (aOR 1.76 (95% CI 1.32–2.35)) compared to women without ARD. After stratifying by race/ethnicity, the odds of PTB and congenital anomalies were highest among Asian women and the odds of LBW were highest among Hispanic women compared to other race/ethnicity-matched controls (table 1). Further sub-analyses revealed that it was predominantly women with SLE who were contributing to the adverse outcomes seen in the combined ARD group. <h3>Conclusions</h3> Consistent with prior literature, we found that women with ARDs tend to be more likely to have PTB and infants of LBW. To our knowledge, this is the largest study to date to analyse these associations in Asian women. Our results suggest that Asian and Hispanic women with ARDs may disproportionally benefit from additional monitoring throughout pregnancy. Our study raises the need for public health initiatives that can help improve pregnancy outcomes in women with autoimmune rheumatic diseases across all races and ethnicities. <h3>Disclosure of Interest</h3> J. Strouse Shareholder of: None, Grant/research support from: None, Consultant for: None, Employee of: None, Paid instructor for: None, Speakers bureau: None, B. Donovan Shareholder of: None, Grant/research support from: None, Consultant for: None, Employee of: None, Paid instructor for: None, Speakers bureau: None, M. Fatima Shareholder of: None, Grant/research support from: None, Consultant for: None, Employee of: None, Paid instructor for: None, Speakers bureau: None, R. Fernandez-Ruiz Shareholder of: None, Grant/research support from: None, Consultant for: None, Employee of: None, Paid instructor for: None, Speakers bureau: None, L. Jelliffe-Pawlowski Shareholder of: None, Grant/research support from: None, Consultant for: None, Employee of: None, Paid instructor for: None, Speakers bureau: None, R. Baer Shareholder of: None, Grant/research support from: None, Consultant for: None, Employee of: None, Paid instructor for: None, Speakers bureau: None, C. Smith Shareholder of: None, Grant/research support from: None, Consultant for: None, Employee of: None, Paid instructor for: None, Speakers bureau: None, G. Bandoli: None declared, R. Paynter Shareholder of: None, Grant/research support from: None, Consultant for: None, Employee of: None, Paid instructor for: None, Speakers bureau: None, N. Parikh Shareholder of: None, Grant/research support from: None, Consultant for: None, Employee of: None, Paid instructor for: None, Speakers bureau: None, K. Ryckman Shareholder of: None, Grant/research support from: None, Consultant for: None, Employee of: None, Paid instructor for: None, Speakers bureau: None, N. Singh Shareholder of: None, Grant/research support from: None, Consultant for: None, Employee of: None, Paid instructor for: None, Speakers bureau: None