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Pregnancy outcomes in women affected by juvenile idiopathic arthritis (JIA)
Pediatric Rheumatology volume 12, Article number: P206 (2014)
Our aim is to describe pregnancy outcomes in a case series of six women affected by JIA.
We report on six cases of women affected by JIA with a median age of 32,8; median age at onset of 6,1; median age at first delivery of 25,7. (table 1)
In all cases, pregnancy was associated with remission of disease activity, however a post partum flare appeared after 4 pregnancies ( pt 1-4-5-6) and in the first year post-partum. The seven babies were in good condition, without apparent malformation or symptoms of neonatal illness. Only 1 woman was treated during her pregnancy: the number 5 patient received oral cyclosporine for the first 5 months of pregnancy and oral low-dose corticosteroids for all pregnancy; she had an active disease before pregnancy and she had an important flare a few months after delivery.
As reported for pregnant patients affected by RA (Dolhain RJEM 2010), in our cases pregnancy was associated with a remission of disease in 6/6 patients and flare in post-partum period in 4/6 patients, probably depending on increased levels of serum alfa 2 glycoprotein and elevated levels of sex hormones that influence a shift in cytokine production from a Th1 to a Th2 profile. In fact, oestrogens inhibit T-cell function, progesterone stimulates Th2 effects and cortisol has a general immunosuppressive effect.
The number 5 patient was treated with cyclosporine and steroids. No congenital anomalies or increase of death rate were observed in infants exposed to cyclosporine antenatally. Besides low-dose steroids therapy (5-15 mg prednisone daily) does not increase low-birth-weight or small for gestation age infants.
In conclusion, in JIA patients, a stable disease or remission should be reached before pregnancy and should be used safe immunosuppressive drugs to avoid a flare during pregnancy and in post-partum period.
Disclosure of interest
Chakravarty EF: 2003
Chen JS: 2013
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Alpigiani, M.G., Salvati, P., Callegari, S. et al. Pregnancy outcomes in women affected by juvenile idiopathic arthritis (JIA). Pediatr Rheumatol 12 (Suppl 1), P206 (2014). https://doi.org/10.1186/1546-0096-12-S1-P206
- Juvenile Idiopathic Arthritis
- Pregnancy Outcome
- Post Partum
- Juvenile Idiopathic Arthritis Patient