Why Women With RA or Lupus Have Fewer Children

Janis C. Kelly

February 23, 2012

February 23, 2012 — More than half of women with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) have fewer children than originally planned, according to research published online February 16 in Arthritis Care & Research. Contributing factors were higher infertility rates in women with RA, higher miscarriage rates in women with SLE, and concerns about child health, personal welfare, and passing the rheumatolgic condition to the child in both groups.

Investigators Megan E.B. Clowse, MD, MPH, from the Nebraska Medical Center in Omaha, and colleagues conducted this study to determine the effects of decreased fertility, pregnancy loss, and personal choice on family size for women with RA and SLE. The researchers surveyed 1017 female participants in the National Data Bank for Rheumatic Diseases longitudinal observational study.

Respondents to the reproductive-health questionnaire included 578 women with RA and 114 with SLE, categorized as those interested in having children at symptom onset who had either fewer children than planned (group A) or the same number as planned (group B), and those no longer interested in having children at diagnosis (group C, which included 60% of respondents).

The researchers found that 55% of women with RA and 64% of women with SLE had fewer children than originally planned, and that the reasons for this differed between these 2 diagnostic groups.

Infertility: Major Reason for Fewer Children

Infertility was a major reason that women with RA who had fewer children than planned, and the infertility rate of 42% was 1.5 times higher in this subgroup than in those patients with RA who had the same number of children as planned. Miscarriage rates were similar in the 2 groups. In women diagnosed with RA during their childbearing years, the infertility rate was higher than in those diagnosed after childbearing was complete.

"That nearly a third of women diagnosed with RA prior to completion of childbearing experience infertility demands further investigation, with an eye on the impact that current medications have on fertility, both negative and positive," the authors write.

Miscarriage Rates Higher With SLE

Miscarriage rates were 3-fold higher among women with SLE who had fewer children than planned compared with those who had the planned number of children. There was no significant increase in infertility for women with SLE.

The authors write, "In both [RA and SLE] cohorts, the majority of those who developed symptoms prior to the completion of family-building ended up with fewer children than they had originally planned to have."

Among the women with RA in group A, almost 60% did not report infertility, but still had significantly fewer pregnancies and children than those in group B. "This is not explained by pregnancy loss," the authors write. "It appears, instead, that this population of women chose to limit the number of pregnancies due to RA-related concerns (although, interestingly, physician recommendations to avoid pregnancy did not meaningfully affect the number of conceptions)."

Disease-Related Child Welfare Concerns

Women with RA reported concerns about their ability to care for children, concerns that their disease or medications would harm a baby, and concerns that their children would develop RA.

Similarly, among the women with SLE, those with disease-related child-welfare concerns had fewer conceptions, and "the pregnancy rate for women whose physicians advised against pregnancy was similar to that for women whose physicians did not."

The authors conclude, "In both [RA and SLE] groups of women, concerns about inability to care for a child, damage from medications, and genetic transmission of their disease lead to fewer pregnancies. Concerns about disability impairing ability to care for children can only be addressed through improved disease management. Concerns about medication effects on offspring, however, should be managed through improved education of physicians and patients; there are safe medical options during pregnancy that can both control disease activity and prevent negative outcomes for the developing fetus. Similarly, concerns about genetic transfer of rheumatologic disease may be exaggerated and potentially reversed with improved patient education."

The study was funded by the Arthritis Foundation Arthritis Investigator Award. The authors have disclosed no relevant financial relationships.

Arthritis Care Res. Published online February 16, 2012. Abstract

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