Pregnancy outcomes in juvenile idiopathic arthritis: systematic review and meta-analysis

Abstract

Objectives: To investigate the relationship between juvenile idiopathic arthritis (JIA) and pregnancy outcomes. Methods: A comprehensive literature review was conducted by searching for published articles indexed in Pubmed, Embase, Scopus, and Web of Science databases from inception through January 2025. All observational studies that compared the risk of any pregnancy outcomes of women with and without JIA were identified. Pooled risk ratio (RR) and 95% confidence intervals (CI) were calculated using the random-effect, generic inverse variance method of DerSimonian and Laird. Results: A total of 196 articles were identified, and 11 studies fulfilled the inclusion criteria and were included in the meta-analysis. For maternal outcomes and delivery outcomes of pregnant JIA women, there was an increased risk of developing preeclampsia/eclampsia (RR 1.54, 95% CI 1.07–2.22; I² 72.68%), undergoing cesarean section (RR 1.50, 95% CI 1.23–1.83; I² 88.47%), and postpartum hemorrhage (RR 2.12, 95% CI 1.08–4.16; I² 88.77%). For neonatal outcomes, there was an increased risk of preterm birth (RR 1.74, 95% CI 1.33–2.26; I² 84.23%) and being small for gestational age (RR 1.20, 95% CI 1.08–1.33; I² 84.23%). No significant increase was detected in the risk of pregnancy-induced hypertension (RR 1.74, 95% CI 0.93–3.26; I² 86.58%), gestational diabetes (RR 0.96, 95% CI 0.65–1.44; I² 52.41%), and stillbirth (RR 1.38, 95% CI 0.78–2.44; I² 0.00%). Conclusion: JIA is associated with higher risks of preeclampsia, undergoing cesarean section, postpartum hemorrhage, small-for-gestational-age infants, and preterm birth.