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Fæðingarsaga kvenna með alvarlega liðbólgusjúkdóma: Niðurstöður frá ICEBIO og Fæðingaskrá

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Authors
Signý Rut Kristjánsdóttir
Þóra Steingrímsdóttir
Gerður Gröndal
Ragnheiður I. Bjarnadóttir
Kristjana Einarsdóttir
Björn Guðbjörnsson
Issue Date
2019-06

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Other Titles
Pregnancy outcomes in Icelandic female patients with inflammatory arthritides. Nationwide results from the ICEBIO and the Icelandic Medical Birth Register
Citation
Fæðingarsaga kvenna með alvarlega liðbólgusjúkdóma: niðurstöður frá ICEBIO og Fæðingaskrá. 2019, 105(6): 267-275 Læknablaðið
Abstract
Inngangur: Mikilvægt er að leita frekari þekkingar á meðgöngu og fæðingu hjá konum með liðbólgusjúkdóma. Staðan hérlendis er óþekkt og höfum við því samkeyrt ICEBIO og Fæðingaskrá Embættis landlæknis til að kanna hugsanleg áhrif alvarlegra liðbólgusjúkdóma á meðgöngur og fæðingar íslenskra kvenna. Efniviður og aðferðir: Skoðuð voru gagnlíkindahlutföll fyrir áhættu fyrirburafæðingar, keisaraskurðar, lágrar Apgar-einkunnar nýbura við 5 mínútur og lágrar fæðingarþyngdar, fyrir hvern sjúkdómshóp (iktsýki, sóragigt, hryggikt og óskilgreinda liðbólgu) miðað við viðmiðunarhópa. Meðgöngur og fæðingar eftir upphaf TNFα-hemlameðferðar (TNFi) voru bornar saman við fæðingar fyrir TNFi-meðferð og viðmiðunarhóp, með tilliti til sömu þátta. Niðurstöður: Í lok árs 2016 voru 723 konur sem hafa fengið meðferð með TNFi skráðar í ICEBIO. Af þeim höfðu 412 fætt samtals 801 barn. Þar af fæddust 597 börn fyrir sjúkdómsgreiningu móður og 53 börn eftir að meðferð með TNFi hófst. Hlutfallsleg hætta á keisaraskurði meðal þessara kvenna var 1,47 (95% ÖB: 1,19-1,82; p<0,001), hæst meðal kvenna með sóragigt, eða 2,06 (1,41-3,02; p<0,001). Ekki mældist aukin hætta á fyrirburafæðingu eða lágri Apgar-einkunn. Hætta á lágri fæðingarþyngd var minni meðal kvenna með liðbólgusjúkdóma, eða 0,37 (0,36-0,37; p<0,05). Ekki fengust marktækar samanburðarniðurstöður fyrir fæðingar eftir að TNFi-meðferð hófst vegna fárra fæðinga (n=53). Ályktun: Íslenskar konur með alvarlega liðbólgusjúkdóma eru líklegri til að fæða með keisaraskurði en heilbrigður viðmiðunarhópur. Nýburum þeirra vegnar jafn vel og nýburum annarra kvenna. Ekki liggja fyrir næg gögn um fæðingar eftir upphaf TNFi-meðferðar til þess að hægt sé að álykta um áhrif TNFi á meðgöngur og fæðingar íslenskra kvenna með alvarlega liðbólgusjúkdóma.
Introduction: To collect nationwide data in Iceland on pregnancy and its outcomes among female patients with active inflammatory arthritides we linked two registers, the ICEBIO register and the Icelandic Medical Birth Register. Methods: We used multivariate analysis to evaluate the risk of preterm birth, Caesarean section, low Apgar score at 5-minutes and low birth weight among females with inflammatory arthritis (rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) in comparison with healthy controls matched on age and parity. We also investigated pregnancies before and after the diagnosis of respective rheumatic disease and especially in respect to treatment with TNFα inhibitors (TNFi). Results: In the end of 2016, 723 female patients were registered in ICEBIO as they had received treatment with TNFi due to inflammatory arthritis. Of those, 412 women had given birth to 801 children, whereof 597 were delivered before confirmed diagnosis of the mother and 53 were delivered after the start of the TNFi treatment. Relative risk of Caesarean section among these female with various arthritis conditions were 1.47 (95% CI: 1.19-1.82; p < 0,001) compared to controls and was highest in the group with PsA or 2.06 (1.41-3.02; p<0,001). We did not find increased risk of preterm delivery or low Apgar score. Patients with inflammatory arthritis had lower risk of children with low birth weight or 0.37 compared to healthy controls (95% CI: 0.36-0.37; p < 0.05). Due to low numbers of deliveries after the initiation of TNFi therapy (n=53) we were not able to perform any analysis for that group. Conclusion: Icelandic female patients with inflammatory arthritis are at an increased risk of Caesarean section in comparison to healthy controls. However, their newborns are in good condition and healthy at birth. Analysis of the impact of treatment with TNFi on pregnancy is not yet possible due to limited data.
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https://www.laeknabladid.is/tolublod/2019/06/nr/7070
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