Clinical Edge

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Corticosteroid Use in Pregnancy Linked to Preterm Birth

Key clinical point: Oral corticosteroid use in pregnancy for rheumatoid arthritis is linked to higher risk of preterm birth.

Major finding: Pregnant women on higher doses of oral corticosteroids for rheumatoid arthritis have more than fourfold higher risk of preterm birth.

Study details: A study of 528 pregnant women with rheumatoid arthritis.

Disclosures: The study was supported by the National Institutes of Health, and the MotherToBaby Pregnancy Studies are supported by research grants from several pharmaceutical companies. No other conflicts of interest were declared.

Commentary:

Evidence regarding medication use in pregnant women with RA is limited due to a lack of large-scale controlled studies. It has been recognized that the use of corticosteroids during pregnancy carries a risk for gestational diabetes and hypertension, as well as for premature rupture of membranes and small-for-gestational-age infants. This study found that the risk of preterm birth was greater in women with RA who used glucocorticoids, both in early and late pregnancy, compared with women who did not use glucocorticoids. DMARDs were not associated with an increased risk of preterm birth. The study was based on registry information and phone call follow-up, but lends further weight to the importance of the control of RA activity during pregnancy.— Arundathi Jayatilleke, MD