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Rheumatoid arthritis
Original research
Parenting problems postpartum can be detected early in pregnancy in patients with rheumatoid arthritis
  1. Hieronymus T W Smeele,
  2. Yael A de Man,
  3. Esther Röder,
  4. Hetty Wintjes,
  5. J M W Hazes and
  6. Radboud J E M Dolhain
  1. Rheumatology, Erasmus MC, Rotterdam, Netherlands
  1. Correspondence to Hieronymus T W Smeele; h.smeele{at}erasmusmc.nl

Abstract

Objective To describe parenting disability postpartum in patients with rheumatoid arthritis (RA) using the Parenting Disability Index and to determine early in pregnancy which patients will face parenting problems postpartum.

Methods Data were collected from a prospective study on pregnancy and RA (Pregnancy induced Amelioration of Rheumatoid Arthritis study). Postpartum visits were performed at 6, 12 and 26 weeks after delivery. Domains causing parenting difficulties were identified. A multivariate logistic regression model to identify which patients develop parenting disabilities postpartum with patient characteristics in the first trimester as covariates was performed.

Results 148 patients were eligible for this study. The domains carrying, hygiene, feeding, getting up and down, and household/shopping were frequently scored as difficult. Maintaining discipline, taking care of the children when sick, listening and having other children over caused the least problems. 30.1% of patients with RA report low parenting disability, 30.9% reports intermediate disability and 39.0% reports high disability. Patients with a low Health Assessment Questionnaire (HAQ)-score in the first trimester (OR 9.2, 95% CI 3.0 to 27.7, p<0.001) and low disease activity in the first trimester (Disease Activity Score 28-joint count C reactive protein<3.2) (OR 4.8, 95% CI 1.8 to 12.9, p=0.002) were likely to report low parenting disability postpartum. Patients with a longer disease duration (OR 0.87, 95% CI 0.79 to 0.95, p=0.003) were less likely to report low parenting disability postpartum. A high HAQ-score in the first trimester (OR 4.54, 95% CI 1.99 to 10.34, p<0.001) and erosive disease (OR 2.32, 95% CI 1.00 to 5.35, p=0.049) increased the risk of high parenting disability postpartum.

Conclusion Physical domains of parenting postpartum are most commonly affected in patients with RA. When counselling patients with RA, a HAQ-score in the first trimester is the most reliable marker to identify patients that develop parenting disability after delivery.

  • Arthritis, Rheumatoid
  • Patient Reported Outcome Measures
  • Epidemiology
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/rmdopen-2020-001276

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    Footnotes

    • Contributors All authors had a contribution to the conception and/or design of the manuscript and/or the acquisition/analysis/interpretation of the data. They revised the manuscript critically and gave final approval. HTWS and RJEMD take full responsibility for all aspects regarding the accuracy and integrity of the work.

    • Funding This work was supported by the Dutch Arthritis Foundation (ReumaNederland) (project number: LLP-26). RJEMD received an unrestricted grant from UCB Pharma.

    • Competing interests RJEMD received an unrestricted grant from UCB Pharma.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.