Dataset Information

Brief Report: Patterns and Secular Trends in Use of Immunomodulatory Agents During Pregnancy in Women With Rheumatic Conditions.

ABSTRACT: To describe patterns and secular trends in the use of immunomodulatory agents in pregnant women with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS).We identified a cohort of women with SLE, RA, PsA, or AS enrolled in public (Medicaid, 2001-2010) or private (Optum Clinformatics, 2004-2012) health insurance, and we included women filling prescriptions for immunomodulatory agents (including steroids, nonbiologic disease-modifying agents, and biologic agents) in the 3-month period immediately prior to their pregnancies. The proportion of women continuing or discontinuing individual agents during pregnancy was reported. Annual prescription fill rates, estimated after accounting for patient characteristics and random variability from year to year in mixed-effects regression models, were used to conduct time trends analysis.We included 2,645 women being treated with immunomodulatory agents prior to pregnancy. More women with PsA or AS stopped filling prescriptions for immunomodulatory agents during pregnancy (61%) than women with SLE (26%) or women with RA (34.5%). From the first to the third trimester, the proportions of women filling prescriptions for immunomodulatory agents decreased across all indications. Overall, steroids and hydroxychloroquine were the most frequently used agents in pregnancy (48.4% and 27.1%, respectively). The rates (reported per 100 deliveries in our cohort) for steroid prescription fills during pregnancy decreased significantly from 54.4 in 2001 to 42.4 in 2012, while rates for biologic agents increased from 5.1 in 2001 to 16.6 in 2012 (P < 0.001 for both trends).Steroids and hydroxychloroquine remain the most widely prescribed treatment options in pregnancy, but the use of biologic agents is becoming increasingly common.

SUBMITTER: Desai RJ

PROVIDER: S-EPMC4848128 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Brief Report: Patterns and Secular Trends in Use of Immunomodulatory Agents During Pregnancy in Women With Rheumatic Conditions.

Desai Rishi J RJ Huybrechts Krista F KF Bateman Brian T BT Hernandez-Diaz Sonia S Mogun Helen H Gopalakrishnan Chandrasekar C Patorno Elisabetta E Kim Seoyoung C SC

Arthritis & rheumatology (Hoboken, N.J.) 20160501 5

<h4>Objective</h4>To describe patterns and secular trends in the use of immunomodulatory agents in pregnant women with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS).<h4>Methods</h4>We identified a cohort of women with SLE, RA, PsA, or AS enrolled in public (Medicaid, 2001-2010) or private (Optum Clinformatics, 2004-2012) health insurance, and we included women filling prescriptions for immunomodulatory agents (including s ...[more]

PMID: 26606742

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Project description:BackgroundLinkages between snack patterns, diet, and obesity in adolescents likely depend on the consumption of main meals, how often snacks are prepared away from home, and whether energy-dense, nutrient-poor snack foods and sugary drinks are frequently consumed. Nutrition-based interventions need to be informed by an understanding of how secular changes in the contribution of snacks to dietary intake may be related to changes in meal frequency as well as how these trends differ by sociodemographic characteristics.ObjectivesTo examine secular trends from 1999 to 2010 in meal and snack patterns among adolescents.DesignA repeated cross-sectional design was used.Participants/settingParticipants from Minneapolis/St Paul, MN, secondary schools completed classroom-administered surveys and food frequency questionnaires in 1999 (n=2,598) and 2010 (n=2,540).Main outcome measuresWeekly meal frequencies; number of snacks consumed on school and vacation/weekend days; frequent consumption of snacks prepared away from home (≥3 times/week); and daily servings of energy-dense, nutrient-poor food/drinks that are commonly consumed at snack occasions.Statistical analyses performedTrends from 1999 to 2010 were examined using inverse probability weighting to control for differences in sociodemographic characteristics in the two samples.ResultsMean frequencies of breakfast and lunch increased modestly in the overall population (both P values <0.001), and there were decreases in the number of snacks consumed on schools days (P<0.001) and vacation/weekend days (P=0.003). Although there was no change in the proportion of adolescents who reported frequent consumption of snacks prepared away from home, there was a secular decrease in energy-dense, nutrient-poor food/drink consumption (P<0.001). Sociodemographic differences in the identified trends were evident.ConclusionsThe observed pattern of sociodemographic characteristic differences in meal and snack trends among adolescents suggests the need for targeted efforts to ensure public health messages reach low-income and ethnic/racial minority population subgroups most vulnerable to poor nutrition and the development of obesity.

Project description:ObjectiveTo measure variance in antiphospholipid antibody (aPL) levels during pregnancy and to determine if variation affects pregnancy outcomes.MethodsWe used data from the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study, a multicenter prospective study of pregnant women with aPL and/or systemic lupus erythematosus (SLE). Antiphospholipid antibodies were considered present if any of the following were positive: anticardiolipin (aCL), anti-β2 -glycoprotein I (anti-β2 GPI) titers ≥40 IgG phospholipid (GPL) or IgM phospholipid (MPL) units, and/or lupus anticoagulant (LAC). Antiphospholipid antibodies were measured every trimester and postpartum. Adverse pregnancy outcomes were defined as fetal/neonatal death, preterm delivery (<36 weeks) due to preeclampsia or placental insufficiency, or growth restriction.ResultsOne hundred fifty-two aPL-positive patients were studied. Fifty-seven percent had clinical antiphospholipid syndrome (APS) and 36% had SLE. IgG aPL levels were significantly lower during the second and third trimesters compared to initial screening, but IgG aCL and anti-β2 GPI remained high-positive through pregnancy in 93% of patients during the second trimester, and in 85% of patients during the third trimester. IgM aPL titers were negative in the majority of patients and decreased modestly during pregnancy among patients who were positive. LAC frequency also decreased, but 75% of patients remained positive through the second trimester. Only 4% of patients with aPL at baseline did not have aPL in either the second or third trimesters. Changes in aPL levels or aPL status were not associated with adverse pregnancy outcomes. LAC was the only aPL associated with adverse pregnancy outcomes.ConclusionThe aPL in the cohort decreased marginally during pregnancy, and changes were not associated with pregnancy outcomes. Our results suggest that, among women with aPL and/or SLE, measuring aPL early in pregnancy is sufficient to assess risk. Repeat aPL testing through pregnancy is unnecessary.

Dataset Information

Brief Report: Patterns and Secular Trends in Use of Immunomodulatory Agents During Pregnancy in Women With Rheumatic Conditions.

Publications

Brief Report: Patterns and Secular Trends in Use of Immunomodulatory Agents During Pregnancy in Women With Rheumatic Conditions.

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