Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr;27(4):430-438.
doi: 10.1002/pds.4410. Epub 2018 Feb 28.

Patterns of Prednisone Use During Pregnancy in Women With Rheumatoid Arthritis: Daily and Cumulative Dose

Affiliations
Free PMC article

Patterns of Prednisone Use During Pregnancy in Women With Rheumatoid Arthritis: Daily and Cumulative Dose

Kristin Palmsten et al. Pharmacoepidemiol Drug Saf. .
Free PMC article

Abstract

Purpose: To characterize prednisone use in pregnant women with rheumatoid arthritis using individual-level heat-maps and clustering individual trajectories of prednisone dose, and to evaluate the association between prednisone dose trajectory groups and gestational length.

Methods: This study included pregnant women with rheumatoid arthritis who enrolled in the MotherToBaby Autoimmune Diseases in Pregnancy Study (2003-2014) before gestational week 20 and reported prednisone use without another oral glucocorticoid during pregnancy (n = 254). Information on medication use and pregnancy outcomes was collected by telephone interview plus by medical record review. Prednisone daily dose and cumulative dose were plotted by gestational day using a heat map for each individual. K-means clustering was used to cluster individual trajectories of prednisone dose into groups. The associations between trajectory group and demographics, disease severity measured by the Health Assessment Questionnaire at enrollment, and gestational length were evaluated.

Results: Women used prednisone 3 to 292 days during pregnancy, with daily doses ranging from <1 to 60 mg. Total cumulative dose ranged from 8 to 6225 mg. Disease severity, non-biologic disease modifying anti-rheumatic drug use, and gestational length varied significantly by trajectory group. After adjusting for disease severity, non-biologic disease modifying anti-rheumatic drug use, and other covariates, the highest vs lowest daily dose trajectory group was associated with reduced gestational age at delivery (β: -2.3 weeks (95%: -3.4, -1.3)), as was the highest vs lowest cumulative dose trajectory group (β: -2.6 weeks (95%: -3.6, -1.5)).

Conclusions: In pregnant women with rheumatoid arthritis, patterns of higher prednisone dose were associated with shorter gestational length compared with lower dose.

Keywords: cluster analysis; gestational age; glucocorticoids; pharmacoepidemiology; prednisone; pregnancy; rheumatoid arthritis.

Figures

Figure 1
Figure 1
Daily dose of prednisone during pregnancy for each individual by gestational day. Within the graphs, each horizontal line represents a woman's pregnancy. The colors encode the reported dose of prednisone used on each gestational day. Vertical bars represent the delivery day. The dashes represent days during pregnancy with no prednisone use. Asterisks indicate women with incomplete prednisone dose information. The color legend for daily dose is depicted at the top of the figure.
Figure 2
Figure 2
Cumulative dose of prednisone during pregnancy for each individual by gestational day. Within the graphs, each horizontal line represents a woman's pregnancy. The colors encode the reported cumulative dose of prednisone used since the start of pregnancy on each gestational day. Vertical bars represent the delivery day. The dashes to the left of the colors represent days before prednisone was initiated during pregnancy. Asterisks indicate women with incomplete prednisone dose information. The color legend for cumulative dose is depicted at the top of the figure.
Figure 3
Figure 3
Prednisone daily dose trajectory groups. The solid lines represent the observed mean dose on each gestational day for each group and the shaded areas represent 95% confidence intervals.
Figure 4
Figure 4
Prednisone cumulative dose trajectory groups. The solid lines represent the observed mean cumulative dose on each gestational day for each group and the shaded areas represent 95% confidence intervals.

Similar articles

See all similar articles

Cited by 3 articles

Publication types

Feedback