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Parenting problems postpartum can be detected early in pregnancy in patients with rheumatoid arthritis
Hieronymus T W Smeele1, Yael A de Man2, Esther Röder2
1Rheumatology, Erasmus MC, Rotterdam, Netherlands h.smeele@erasmusmc.nl.
Insights
Patients with rheumatoid arthritis (RA) frequently experience parenting difficulties postpartum, particularly with physical tasks. Early pregnancy Health Assessment Questionnaire (HAQ) scores reliably predict postpartum parenting challenges in RA patients.
Area of Science:
- Rheumatology
- Obstetrics
- Psychology
Background:
- Rheumatoid arthritis (RA) can impact physical function, potentially affecting parenting roles.
- Understanding postpartum parenting challenges in RA patients is crucial for targeted support.
Purpose of the Study:
- To describe parenting disability in RA patients postpartum using the Parenting Disability Index.
- To identify early pregnancy predictors of postpartum parenting difficulties in RA patients.
Main Methods:
- Prospective study data from the Pregnancy induced Amelioration of Rheumatoid Arthritis (PIRA) study.
- Postpartum visits at 6, 12, and 26 weeks to assess parenting domains.
- Multivariate logistic regression using first-trimester characteristics to predict postpartum parenting disability.
Main Results:
- Physical domains like carrying and hygiene were common difficulties for RA patients postpartum.
- 39% of RA patients reported high postpartum parenting disability.
- Low Health Assessment Questionnaire (HAQ) scores and low disease activity in early pregnancy predicted low postpartum parenting disability.
- Longer disease duration, high HAQ scores, and erosive disease increased the risk of high postpartum parenting disability.
Conclusions:
- Physical aspects of parenting are most frequently impacted in RA patients postpartum.
- Early pregnancy HAQ scores are the most reliable predictor for identifying RA patients at risk of postpartum parenting disability.
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.
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