A multi-center study of a national survey published in Arthritis Care and Research, a journal of the American College of Rheumatology (ACR), has established that over half of women with rheumatoid arthritis (RA) and systematic lupus erythematosus (SLE) have fewer children than desired.
Leading researcher, Kaleb Michaud, Ph.D., assistant professor in the internal medicine department-rheumatology section at the University of Nebraska Medical Center, and his team established that whilst patients' choices are partly responsible for having smaller family sizes, the survey results suggest that higher infertility rates and miscarriages may also affect the number of babies born to those suffering from these chronic conditions.
According to ACR estimates, almost 322,000 U.S. adults suffer from systemic lupus, a disease whereby the body's immune system becomes overactive, attacking healthy cells, tissues, or organs, whilst about 1.3 million adult Americans have RA, a chronic autoimmune disease causing painful joint inflammation. Medical evidence has shown that both RA and SLE are more prevalent in women, and given that the disease often starts to occur during a woman's reproductive years, it can result in problems starting a family.
The study, which was conducted to gain a better insight into reasons of infertility, pregnancy loss and family choice in women with RA and SLE involved surveying 1,017 women registered in the National Data Bank for Rheumatic Diseases, of whom 578 women with RA and 114 with SLE responded.
The researchers categorized the women into three separate groups. Group A consisted of those interested in having children, but who had fewer than planned, Group B consisted of women who wanted children and who had the number of children they planned, and Group C consisted of those who were no longer interested in having children after being diagnosed with RA or SLE.
The results of the study demonstrated that over 60% of participants belonged to Group C, and that 55% of women with RA, and 64% of those with SLE had fewer children than originally planned.
The infertility rate of women with RA in group A was 1.5 times higher, compared with those in group B, however, both groups had similar rates of miscarriage, and even though women with SLE in group A had a comparable number of pregnancies to those in group B, their rate of miscarriage was three times higher. Furthermore, it showed that 42% of women with RA had an overall infertility rate of 42%, and had fewer children than desired.
Women who were diagnosed with RA during their childbearing years had a higher infertility rate, compared with those who were diagnosed after childbearing was complete. There was no substantial increase in fertility in those with SLE, yet women with lupus were observed to have fewer children than desired, which was linked to miscarriage.
Other reasons for fewer pregnancies in women with RA and SLE were reported as the inability to care for their children, adverse effects from medications taken during pregnancy as well as concerns of genetically transmitting the disease to their offspring.
Dr. Michaud said:
"Rheumatoid arthritis and lupus and their treatments can pose major problems for women during pregnancy and can even result in birth defects and spontaneous abortion. We hope this study will bring these reproductive-health concerns to the forefront, especially among women in their childbearing years."
The researchers indicate that educating patients and raising their awareness of safe medical options during pregnancy, together with effectively controlling these autoimmune diseases will help women to achieve their family planning goals.
Dr. Michaud calls for further studies to investigate the underlying causes of infertility and pregnancy loss in women with RA and SLE.
Written by Petra Rattue