Improved pregnancy outcome in patients with Rheumatoid Arthritis who followed an ideal clinical pathway

OBJECTIVE: Among women with rheumatoid arthritis (RA) we aimed to assess the effect of optimal management of pregnancy, on a composite outcome of miscarriage and complicated birth. METHODS: Data were extracted from healthcare databases of the Lombardy Region, Italy (2004-2013), as a part of the RECord-linkage On Rheumatic Diseases Study. Analyses included women with RA identified through copayment exemption code (ICD9-CM code 714.0) and controls from the general population aged between 18 and 50. Seven healthcare quality indicators (HCQI) were constructed and summarized in 3 pathways indicators: A) diagnostic; B) therapeutic; C) and prenatal follow-up. The groups of complicated birth or miscarriage identified the adverse pregnancy outcome (APO). The relationship between HCQI and APO was analysed using logistic models and the results presented as odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: The study cohort included the first pregnancy observed in 443 patients with RA compared with 6097 women belonging to the general population. In RA population, patients who followed the ideal pathway had a reduced risk of overall APO with an OR=0.60 (95%CI 0.39, 0.94) and of miscarriage/perinatal death with an OR=0.40 (95%CI 0.24, 0.69) compared to those who did not. Compared with the general population, patients with RA who met all HCQI during pregnancy displayed a risk of APO with an OR=0.92 (95%CI 0.61, 1.38) and miscarriage/perinatal death with an OR=0.77 (95%CI 0.47,1.29). CONCLUSIONS: The adherence to the ideal clinical pathway in women with RA restored the risk of APO to that expected for the general population.