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The Recurrence Risk of Adverse Outcome in the Second Pregnancy in Women With Rheumatic Disease

From the Department of Rheumatology, Center for Mothers with Rheumatic Disease, University Hospital of Trondheim, Trondheim; and Medical Birth Registry of Norway, Locus of Registry Based Epidemiology, University of Bergen, Bergen, Norway.

Address reprint requests to: Johan F. Skomsvoll, MD, University Hospital of Trondheim, Center for Mothers With Rheumatic Disease, Department of Rheumatology, 7006 Trondheim, Norway; E-mail: johan.skomsvoll{at}medisin.ntnu.no.

OBJECTIVE: To study recurrence risks of adverse pregnancy outcome in the second pregnancy in women with rheumatic disease.

METHODS: In a national population-based cohort study, women with rheumatic disease recorded from 1967 to 1995 in the Medical Birth Registry of Norway were compared with mothers without such diagnoses with regard to recurrence risks of adverse pregnancy outcomes in the second pregnancy. The odds ratios (ORs) of all outcomes were adjusted for maternal age, those of cesarean delivery for time period, and those of preeclampsia for interpregnancy interval.

RESULTS: Women with rheumatic disease and adverse pregnancy outcome in the first pregnancy had a statistically significant higher recurrence risk of the same event in the second pregnancy than women without rheumatic disease (preeclampsia: OR 2.22; 95% confidence interval [CI] 1.18, 4.19) (cesarean delivery: OR 1.52; 95% CI 1.05, 2.21) (preterm birth: OR 1.86; 95% CI 1.12, 3.11). In women with rheumatic disease diagnosed between the first and second births, a significantly increased recurrence risk of low birth weight occurred. Women with rheumatic disease also had a higher occurrence of markers for placental dysfunction (preeclampsia, preterm birth, or small for gestational age) in the second birth after any of these outcomes in the first birth (OR 1.35; 95% CI 1.02, 1.78) (35.1% versus 29.2%).

CONCLUSION: The recurrence risk of an adverse outcome in the second pregnancy is increased in any woman, but was even higher in women with a rheumatic disease. These patients should be counseled accordingly, be closely monitored during pregnancy, and have access to appropriate subspecialists.

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