Pregnant women taking high doses of steroids for their autoimmune inflammatory diseases are at higher risk of developing a serious infection than those on lower steroid doses, according to a study.
The risk of infection is similar when women take non-steroid immunosuppressive therapies, the research also showed.
Researchers looked at 4,961 women in their study, “Risk of serious infections associated with use of immunosuppressive agents in pregnant women with autoimmune inflammatory conditions: cohort study.” It was published in the journal The BMJ.
Women with autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, psoriatic arthritis, and inflammatory bowel disease are treated with immunosuppressive drugs. The medication dampens their immune system response.
Because pregnant women can have higher disease activity, doctors keep them on the treatment to reduce the risk of premature births, intrauterine growth restrictions, and miscarriages.
Immunosuppressive drugs increase the risk of infection, however, because they interfere with a patient’s immune response against microbes. Also, pregnancy per se alters immune responses. Altogether, this means these women may be more susceptible to severe infection.
The mean age of the pregnant women the research team followed was 29. The breakdown in the diseases they were being treated for was systemic lupus erythematosus, 36.8%; rheumatoid arthritis, 36.2%; inflammatory bowel disease, 22.6%; ankylosing spondylitis, 11.7%; and psoriatic arthritis, 2.9%.
Researchers wanted to know whether the women’s risk of serious infection depended on the treatment. So they divided participants into three groups: those on steroids, 2,598; those on non-biologic or synthetic drugs, 1,587; and those on TNF inhibitors, 776.
Then the team studied the infections the women developed. They included meningitis, encephalitis, pneumonia, tuberculosis and systemic candidiasis.
The researchers discovered that 71 women, or 0.2%, treated with immunosuppressive agents developed serious infections. The frequency of serious infection was 3.4% in women treated with steroids, 2.3% in those taking non-biological drugs, and 1.5% in those on TNF inhibitors. The differences in the numbers were not statistically significant.
Only women on a higher steroid dose were at increased risk of developing a serious infection during pregnancy, compared with those on lower steroid doses. Researchers defined lower doses as an average of less than 10 mg per day.
“Findings from this large-scale population-based cohort study of pregnant women with systemic inflammatory conditions suggest that risk of serious infections is similar among users of steroids, non-biologics, and TNF inhibitors. However, the use of high-dose steroids is an independent risk factor of serious infections in pregnancy,” the team concluded.