Higher Rates of Infertility and Pregnancy Loss Likely Behind Lower than Desired Family Size
New research shows that more than half of women with rheumatoid
arthritis (RA) and systemic lupus erythematosus (SLE) have fewer
children than desired. While patient choice has some influence on the
smaller family size, findings published today in Arthritis
Care & Research, a journal of the American College of
Rheumatology (ACR), suggest that higher rates of infertility and
miscarriage may also impact the number of offspring born to women with
these chronic conditions.
According to the ACR up to 322,000 U.S. adults have systemic lupus—a
disease in which the body’s immune system becomes overactive and attacks
healthy cells, tissues, or organs. Roughly 1.3 million adult Americans
suffer from RA, a chronic autoimmune disease that causes painful joint
inflammation. Medical evidence reports that both RA and SLE are more
common in women, and onset often occurs during reproductive years which
can lead to challenges in family-building.
To further understand the role of infertility, pregnancy loss and family
size choice in women with RA and SLE, Megan Clowse, M.D., Kaleb Michaud,
Ph.D. and colleagues from institutes across the U.S. surveyed 1,017
female participants in the National Data Bank for Rheumatic Diseases.
Respondents to the reproductive-health questionnaire included 578 women
with RA and 114 with SLE, who based upon their responses, were then
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).
Study findings reveal that over 60% of respondents were in group C.
Researchers found that 55% of women with RA and 64% with SLE had fewer
children than originally planned. Women with RA who were in group A had
an infertility rate 1.5 times higher than those in group B, but both
groups had similar rates of miscarriage. Women with SLE in group A had a
similar number of pregnancies as those in group B, but a 3-fold higher
miscarriage rate.
Overall the infertility rate among participants with RA was 42% in women
who had fewer children than desired. In women diagnosed with RA during
childbearing years the infertility rate was higher than in those
diagnosed after childbearing was complete. For participants with SLE no
significant increase in infertility was noted. However, among women with
lupus having fewer children than desired was associated with pregnancy
loss. The authors suggest that patient education to enhance awareness of
safe medical options during pregnancy and effective control of these
autoimmune diseases will assist women with achieving their childbearing
goals.
“Our study highlights important reproductive-health concerns for women
with RA and lupus,” said Dr. Clowse. Study findings reported that
concerns about inability to care for their children, adverse effects
from medications taken during pregnancy, and genetic transmission of
their disease to offspring lead to fewer pregnancies in women with RA
and SLE. “Further study of the underlying causes of infertility and
pregnancy loss in women with RA and SLE is needed to help fulfill their
desire for children,” concludes Dr. Clowse.
