Dr. Hernández-Díaz has received consultant fees (less than $10,000 each) from AstraZeneca, Novartis, and GlaxoSmithKline Biologicals.
Disease-Modifying Antirheumatic Drugs
Use of disease-modifying antirheumatic drugs during pregnancy and risk of preeclampsia
Version of Record online: 30 OCT 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 11, pages 1730–1738, November 2012
How to Cite
Palmsten, K., Hernández-Díaz, S., Kuriya, B., Solomon, D. H. and Setoguchi, S. (2012), Use of disease-modifying antirheumatic drugs during pregnancy and risk of preeclampsia. Arthritis Care Res, 64: 1730–1738. doi: 10.1002/acr.21807
- Issue online: 30 OCT 2012
- Version of Record online: 30 OCT 2012
- Manuscript Accepted: 9 JUL 2012
- Manuscript Received: 19 DEC 2011
- National Institute of Child Health and Human Development
- Agency for Healthcare Research and Quality. Grant Numbers: R21HD055479, R01HS018533
- National Institute of Child Health and Human Development. Grant Number: Training Grant T32 HD060454
- NIH. Grant Number: K24-AR055989
- Agency for Healthcare Research and Quality. Grant Number: K02-HS017731
- US Department of Health and Human Services
To describe patterns of disease-modifying antirheumatic drug (DMARD) use during pregnancy in a population-based cohort, and to evaluate the association between autoimmune disease, DMARDs, corticosteroids, and nonsteroidal antiinflammatory drugs (NSAIDs) and preeclampsia.
Using health care utilization databases from British Columbia (1997–2006), we compared the risk for preeclampsia among 44,786 women with and without autoimmune disease with study drug dispensings before pregnancy (past users) and before and during the first 20 gestational weeks (continuous users). Relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated.
Only 414 women (0.1%) had a DMARD dispensing during pregnancy. The incidence of preeclampsia was 2.3% for past DMARD users, 2.7% for past corticosteroid users, and 2.9% for past NSAID users. Compared to past users, the continuous DMARD user RR was 2.29 (95% CI 0.81–6.44), and was 0.89 (95% CI 0.51–1.56) for corticosteroid and 0.84 (95% CI 0.63–1.10) for NSAID users. Compared to women without autoimmune disease, the delivery year–adjusted RR was 2.02 (95% CI 1.11–3.64) for women with systemic lupus erythematosus (SLE). The DMARD results were attenuated when antimalarials were excluded, and the delivery year–adjusted RR was 0.95 (95% CI 0.25–3.55) when the DMARD analysis was restricted to women with autoimmune disease.
Few women were exposed to DMARDs during pregnancy. We observed a 2-fold increased risk of preeclampsia among women with SLE and a nonsignificant increase in risk in DMARD users. The DMARD and preeclampsia association was attenuated when antimalarials were excluded and null when restricted to women with autoimmune disease, which suggests the association is likely due to greater autoimmune disease severity in DMARD users.