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Juvenile onset arthritis and pregnancy outcome: a population-based cohort study
  1. Katarina Remaeus1,2,
  2. Kari Johansson1,
  3. Johan Askling1,3,
  4. Olof Stephansson1,2
  1. 1Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska University Hospital and Institutet, Stockholm, Sweden
  2. 2Department of Women’s and Children’s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Katarina Remaeus, Department of Medicine, Solna, Clinical Epidemiology Unit, T2, Karolinska University Hospital and Institutet, 171 76 Stockholm, Sweden; katarina.remaeus{at}


Objectives Reports on pregnancy outcomes among women with juvenile onset arthritis (JIA) have been few and small. The aim of this study was to assess pregnancy outcomes in a large and contemporary cohort of women diagnosed with JIA.

Methods In a nationwide Swedish population-based cohort study between 1992 and 2011, we identified 1807 births among women with JIA and 1 949 202 control births. Since JIA is a heterogenic condition, births to women with JIA was divided into JIA paediatric only (n=1169) and JIA persisting into adulthood (n=638). ORs and 95% CIs were estimated with generalised estimating equations.

Results Women with JIA were at increased risk of preterm birth, especially medically indicated, in both subgroups: adjusted OR (aOR) 1.74 (1.35–2.67) for JIA paediatric and aOR 4.12 (2.76–6.15) for JIA persisting into adulthood. JIA persisting into adulthood was associated with very preterm birth (aOR 3.14, 1.58–6.24), spontaneous preterm birth (aOR 1.63, 1.11–2.39), small for gestational age birth (aOR 1.84, 1.19–2.85), early-onset pre-eclampsia (aOR 6.28, 2.68–13.81) and late-onset pre-eclampsia (aOR 1.96, 1.31–2.91). Women with JIA paediatric only were at increased risk of delivery by caesarean section (aOR 1.42, 1.66–1.73) and induction of labour (aOR 1.45, 1.18–1.77).

Conclusions We found increased risks of both maternal and infant complications among women with JIA confined to childhood and in women with JIA persistent into adulthood as compared with population controls. Pregnancies in women with JIA should thus be subject to increased surveillance during pregnancy and delivery.

  • juvenile idiopathic arthritis
  • epidemiology
  • arthritis

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  • Contributors Study concept and design: KR, OS and JA. Acquisition of data: OS. Statistical analyses: KR and KJ. Drafting of the manuscript: KR and OS. Critical revision of the manuscript for important intellectual content: KR, KJ, JA and OS.

  • Funding JA was funded by the Swedish Cancer Society (Cancerfonden), the Swedish Foundation for Strategic Research (SSF), the Stockholm County Council (ALF), the Swedish Heart-Lung Foundation, the Swedish Research Council (Vetenskapsrådet), and the Nordic Research Council (Nordforsk). JA has research ongoing agreements with Lilly, Pfizer, Samsung, UCB, Roche, Merck. OS was supported by grants from the Swedish Research Council (grant 2013-2429), the Stockholm County Council and the Strategic Research Program in Epidemiology at Karolinska Institutet.

  • Competing interests KR, KJ and OS none declared. JA reports grants from Astra Zeneca, grants from Pfizer, grants from Abbvie, grants from MSD, grants from Roche, grants from UCB, grants from Lilly, grants from Samsung, outside the submitted work and pertaining to safety surveillance of anti-rheumatic drugs using Swedish registers.

  • Patient consent The study is register based, not based on individuals.

  • Ethics approval Ethical approval from Karolinska Institutet, Ethics committee Dnr 2006889-31, Dnr 2007/1391-32,Dnr 2008/631-32,Dnr 2009/1853-32

  • Provenance and peer review Not commissioned; externally peer reviewed.