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Abstract：
OBJECTIVE: We aimed to investigate medication utilisation trends during pregnancy and identify factors associated with adverse pregnancy outcomes (APOs) in patients with rheumatoid arthritis (RA).
METHODS: Female patients with RA aged 20-50 years were identified from the Korean national health insurance database between 2010 and 2020. Pregnancy episodes were divided into two groups according to pregnancy outcome: the delivery group and the APO group (abortion and stillbirth). The characteristics and medication utilisation patterns were compared between the two groups, and multivariable logistic regression analysis was conducted to identify the factors associated with APOs.
RESULTS: A total of 5728 pregnancy episodes were included, comprising 4576 delivery episodes and 1152 APO episodes. The mean maternal age for all pregnancy episodes was 33.7 years; 33.3 years in the delivery group and 33.7 years in the APO group. Hydroxychloroquine was the most commonly used conventional synthetic disease-modifying antirheumatic drug (DMARD) during the preconception period and pregnancy in both groups. The prescription rate of all DMARDs decreased rapidly during pregnancy. In the multivariable analysis, use of methotrexate (adjusted OR (aOR): 2.14, 95% CI 1.57 to 2.92) and leflunomide (aOR: 2.68, 95% CI 1.39 to 5.15) within 3 months before conception was associated with APOs.
CONCLUSIONS: Methotrexate and leflunomide are associated with an increased possibility of APOs, emphasising the importance of appropriate medication adjustment when planning for pregnancy.
METHODS: Female patients with RA aged 20-50 years were identified from the Korean national health insurance database between 2010 and 2020. Pregnancy episodes were divided into two groups according to pregnancy outcome: the delivery group and the APO group (abortion and stillbirth). The characteristics and medication utilisation patterns were compared between the two groups, and multivariable logistic regression analysis was conducted to identify the factors associated with APOs.
RESULTS: A total of 5728 pregnancy episodes were included, comprising 4576 delivery episodes and 1152 APO episodes. The mean maternal age for all pregnancy episodes was 33.7 years; 33.3 years in the delivery group and 33.7 years in the APO group. Hydroxychloroquine was the most commonly used conventional synthetic disease-modifying antirheumatic drug (DMARD) during the preconception period and pregnancy in both groups. The prescription rate of all DMARDs decreased rapidly during pregnancy. In the multivariable analysis, use of methotrexate (adjusted OR (aOR): 2.14, 95% CI 1.57 to 2.92) and leflunomide (aOR: 2.68, 95% CI 1.39 to 5.15) within 3 months before conception was associated with APOs.
CONCLUSIONS: Methotrexate and leflunomide are associated with an increased possibility of APOs, emphasising the importance of appropriate medication adjustment when planning for pregnancy.
摘要：
目的：我们的目的是调查类风湿性关节炎（RA）患者妊娠期间的药物使用趋势，并确定与不良妊娠结局（APO）相关的因素。
方法：从2010年至2020年韩国国家健康保险数据库中确定20-50岁女性RA患者。根据妊娠结局将妊娠事件分为两组：分娩组和APO组（流产和死胎）。比较两组患者的特点和用药模式，并进行多变量逻辑回归分析以确定与APO相关的因素。
结果：共纳入5728次妊娠事件，包括4576次分娩发作和1152次APO发作。所有妊娠事件的平均产妇年龄为33.7岁；分娩组为33.3岁，APO组为33.7岁。羟氯喹是两组孕前和妊娠期间最常用的常规合成抗风湿药（DMARD）。所有DMARDs的处方率在怀孕期间迅速下降。在多变量分析中，在与APO相关的受孕前3个月内使用甲氨蝶呤(校正OR(aOR):2.14,95%CI1.57~2.92)和来氟米特(aOR:2.68,95%CI1.39~5.15).
结论：甲氨蝶呤和来氟米特与APO的可能性增加有关，强调在计划怀孕时适当调整药物的重要性。
方法：从2010年至2020年韩国国家健康保险数据库中确定20-50岁女性RA患者。根据妊娠结局将妊娠事件分为两组：分娩组和APO组（流产和死胎）。比较两组患者的特点和用药模式，并进行多变量逻辑回归分析以确定与APO相关的因素。
结果：共纳入5728次妊娠事件，包括4576次分娩发作和1152次APO发作。所有妊娠事件的平均产妇年龄为33.7岁；分娩组为33.3岁，APO组为33.7岁。羟氯喹是两组孕前和妊娠期间最常用的常规合成抗风湿药（DMARD）。所有DMARDs的处方率在怀孕期间迅速下降。在多变量分析中，在与APO相关的受孕前3个月内使用甲氨蝶呤(校正OR(aOR):2.14,95%CI1.57~2.92)和来氟米特(aOR:2.68,95%CI1.39~5.15).
结论：甲氨蝶呤和来氟米特与APO的可能性增加有关，强调在计划怀孕时适当调整药物的重要性。
