Prepartum education on parental tasks in women with Rheumatoid Arthritis; does it matter?

Abstract

SUMMARY

Introduction Rheumatoid Arthritis (RA) affects woman’s ability to fulfil parenting tasks postpartum, especially if the disease flares after delivery. In current healthcare education, focussed on parental tasks and joint protection, is given by (allied)healthcare professionals. However, whether this education improves and preserves parenting ability is unknown. Difficulties in parenting can be measured using the ‘parenting disability index (PDI)’, PDI scores(PDI’s) provide information of parental tasks. Modified-PDI scores(mPDI’s) take also into account the contribution of arthritis on parenting. The objectives are to investigate whether prepartum education influences the course of (m)PDI’s postpartum and to determine in which domains of (m)PDI difficulty is experienced the most in women with RA postpartum. Methods Current study is embedded in an observational prospective cohort study on pregnancy and RA. Education was registered and (m)PDI‘s were calculated. Associations between (m)PDI‘s and disease activity(DAS28-CRP-3) and other covariates were calculated. A linear Mixed Model analysis was performed for associations over time with (m)PDI‘s as dependent variables. Results Nineteen percent of 173 women had prepartum education. All mean (m)PDI’s indicated ‘some disability’(0<(m)PDI≤1). Mean mPDI’s were higher than PDI’s. In educated women, (m)PDI’s show a decrease over time. In non-educated women and total group (m)PDI’s first increases and decreases after 12 weeks postpartum. There was a moderate correlation between (m)PDI’s and DAS28-CRP-3 scores for the total group and non-educated women. However this correlation is weak in the educated women. Over time postpartum (m)PDI’s were analysed with a repeated measurements model. Educated women experienced more disability; PDI’s were 0.148 higher (p=0.043) and mPDI’s 0.169 higher (p=0.064). Activities in which difficulty is experienced the most were carrying, bathing, taking the baby out of the car and household chores. Discussion Current prepartum education did show a different course of (m)PDI’s. The educated women had higher scores, however (m)PDI’s postpartum remained stable while these women experienced an increase of disease activity. In contrast to (m)PDI’s of non-educated women that increased along with the disease activity postpartum. Remarkable is education is only given to a small(19%) number of patients in this cohort. Considering that education has been given to patients who experienced more burden, it may be that current education could be improved. A prospective study on standardized prepartum education is needed. Results could be used in daily care of women with RA during pregnancy to be sufficiently prepared for parenting.