For women with rheumatoid arthritis (RA), adherence to an ideal clinical pathway during pregnancy is associated with a reduced risk for miscarriage and complicated birth, according to a study published online January in Arthritis Care & Research.

Alessandra Bortoluzzi, M.D., Ph.D., from the University of Ferrara in Italy, and colleagues examined the relationship between seven health care quality indicators (HCQI) and adverse pregnancy outcomes (APO; complicated birth or miscarriage). Data were included from first pregnancies in 443 women with RA and 6,097 women from the general population (controls).

The researchers found that among patients with RA, compared with those who did not follow the ideal pathway, those who followed the ideal pathway had a reduced risk for overall APO (odds ratio, 0.60; 95 percent confidence interval, 0.39 to 0.94) and miscarriage/perinatal death (odds ratio, 0.40; 95 percent confidence interval, 0.24 to 0.69). Compared with the general population, patients with RA who met all HCQI during pregnancy had similar risks for APO (odds ratio, 0.92; 95 percent confidence interval, 0.61 to 1.38) and miscarriage/perinatal death (odds ratio, 0.77; 95 percent confidence interval, 0.47 to 1.29).

"Our findings suggest the adherence to an ideal clinical pathway should be strived for as much as possible in order to offer the best possible chances for a successful pregnancy to women with RA," the authors write.

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