Impact of pregnancy on health related quality of life

A Swiss research study (i) investigated patient experiences of the disease course and health related quality of life during and after pregnancy in 10 women with rheumatoid arthritis (RA) and 10 women with ankylosing spondylitis (AS). Twenty-nine age-matched healthy pregnant controls were evaluated by the medical outcomes study short form 36 (SF-36) health survey once at each trimester and at 6, 12, and 24 weeks postpartum. A group of non-pregnant age-matched female patients (40 RA, 16 AS) was studied for comparison.

Impaired physical dimensions as well as increased bodily pain was observed in healthy women in late pregnancy. Patients with rheumatoid arthritis showed improved physical functioning scores in the second trimester and reduced pain in the third trimester. Among pregnant patients, those with ankylosing spondylitis suffered the greatest impairment of health related quality of life during pregnancy. In all patient groups the physical impairment in the third trimester was less pronounced than in healthy controls. Mental health scores remained stable even with persisting active disease during pregnancy, or with a postpartum flare. Pregnancy reduced physical functioning in healthy women and patients, but had no impact on mental and emotional health, even at times of disease aggravation.

Another Swiss study (ii) demonstrated that most patients with RA showed sustained or increased improvement of disease activity during pregnancy. Higher disease activity scores were found in the patients with AS with a frequent increase of disease activity in the second trimester and mitigation of symptoms in the third trimester. Analysis specifically for the patient's assessment of pain showed continuously higher pain scores in the patients with AS than in those with RA. Rank correlation showed good to moderate correlation between most clinical measurements and RA Disease Activity Index (RADAI) or Bath Ankylosing Spondylitis Activity Index (BASDAI), respectively. Functional indices were confounded by physiological changes of late pregnancy..RA can be monitored during and after pregnancy by the swollen joint count and RADAI without interference from pregnancy related symptoms, whereas usual measures of disease activity are not always applicable in pregnant patients with AS.

References:

(i) Forger, F., Ostensen, M., Schumacher, A., and Villiger, P.M. (2005, Oct). Impact of pregnancy on health related quality of life evaluated prospectively in pregnant women with rheumatic diseases by the SF-36 health survey. Ann Rheum Dis. 64(10):1494-9.

(ii) Ostensen, M., Fuhrer, L., Mathieu, R., Seitz, M., and Villiger, P.M. (2004, Oct). A prospective study of pregnant patients with rheumatoid arthritis and ankylosing spondylitis using validated clinical instruments. Ann Rheum Dis. 63(10):1212-7.