A population-based study of caesarean section in women with juvenile idiopathic arthritis

Objectives The literature on delivery methods in women with JIA is limited. Active inflammation is a risk factor for caesarean section (CS) in other arthritic diseases. A CS entails a higher risk for complications than vaginal delivery and restricted physical activity in the first weeks after birth. Our objective was to explore a possible association of inflammatory active disease and the proportion of CS in women with JIA. Methods Data from the Norwegian nationwide observational register RevNatus were linked with data from the Medical Birth Registry of Norway (MBRN). Cases comprised singleton births in women with JIA (n = 196) included in RevNatus from 2010 to 2019. Singleton births registered in the MBRN during the same period of time, excluding births in mothers with rheumatic inflammatory diseases, served as population controls (n = 575 798). Results CS was more frequent in women with JIA (20.4%) and in the subgroup of women with inflammatory active JIA (30.0%) than in population controls (15.6%). Women with active JIA had a risk for elective CS similar to population controls [risk difference 2.3% (95% CI -2.5, 12.9)] and a higher risk for emergency CS [risk difference 14.0% (95% CI 4.3, 27.4)] compared with population controls. Conclusion Women with active JIA had a higher risk for emergency CS, but not elective CS, compared with population controls. Lay Summary What does this mean for patients? Vaginal birth is the preferred choice of delivery. However, a caesarean section (CS) may be a necessary intervention to prevent potential harm to the mother or baby. The reasons for considering a CS include underlying risk factors of the mother, earlier births and psychosocial factors. In women with JIA, active disease, joint damage, medication and health-related quality of life may be additional factors. We compared CS in women with JIA and healthy controls to see if it was more frequent in women with JIA. We found that CS overall was more frequent in women with active JIA than in healthy controls, but was not increased in women with inactive JIA. Women with active JIA had a higher risk for emergency CS compared with healthy controls. The risk for elective CS in women with active JIA was similar to that of healthy controls. Women with JIA who are planning pregnancy or are pregnant are advised to contact their rheumatologist for tighter follow-up, with a goal of well-controlled disease during pregnancy.