Impact of autoimmune rheumatic diseases on birth outcomes: a population-based study

Abstract

ObjectivesAutoimmune rheumatic diseases (ARDs) affect women of childbearing age and have been associated with adverse birth outcomes. The impact of diseases like ankylosing spondylitis and psoriatic arthritis (PsA) on birth outcomes remains less studied to date. Our objective was to evaluate the impact of ARDs on preterm birth (PTB), congenital anomalies, low birth weight (LBW) and small for gestational age (SGA), in a large cohort of women.MethodsWe conducted a propensity score-matched analysis to predict ARD from a retrospective birth cohort of all live, singleton births in California occurring between 2007 and 2012. Data were derived from birth certificate records linked to hospital discharge International Classification of Diseases, ninth revision codes.ResultsWe matched 10 244 women with a recorded ARD diagnosis (rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), antiphospholipid syndrome, PsA); ankylosing spondylitis and juvenile idiopathic arthritis (JIA) to those without an ARD diagnosis. The adjusted OR (aOR) of PTB was increased for women with any ARD (aOR 1.93, 95% CI 1.78 to 2.10) and remained significant for those with RA, SLE, PsA and JIA. The odds of LBW and SGA were also significantly increased among women with an ARD diagnosis. ARDs were not associated with increased odds of congenital anomalies.ConclusionConsistent with prior literature, we found that women with ARDs are more likely to have PTB or deliver an SGA infant. Some reassurance is provided that an increase in congenital anomalies was not found even in this large cohort.

Mediation of Adverse Pregnancy Outcomes in Autoimmune Conditions by Pregnancy Complications: A Mediation Analysis of Autoimmune Conditions and Adverse Pregnancy Outcomes

“…Strengths of this study include the large sample created from birth records and hospital discharge summaries. This birth cohort has been used by other researchers to estimate associations between maternal conditions and pregnancy outcomes (2,34,35). By relying on a large, administrative database, we were able to quantify mediated pathways of relatively rare complications, with further stratification by race/ethnicity to improve generalizability to specific populations.…”

“…Finally, these select autoimmune conditions were chosen based on frequency of occurrence and reported increased risk with adverse pregnancy outcomes. Exposures that occurred with less frequency in our sample (e.g., psoriatic arthritis [n = 116] [2] or ankylosing spondylitis [n = 128] [2]) could not be estimated with a mediation analysis but should be pursued in other data sets with more exposures. Likewise, we were only able to assess pregnancy complications that are coded in discharge summaries and occur with enough frequency to investigate.…”

“…The increased risk of adverse pregnancy outcomes associated with select autoimmune conditions is well documented and has been replicated across multiple data sources (1)(2)(3)(4)(5)(6)(7)(8)(9). Rheumatic conditions such as rheumatoid arthritis (RA), psoriatic arthritis, and systemic lupus erythematosus (SLE) have been associated with increased risk of preterm birth, low birth weight, caesarean delivery, and offspring who are small for gestational age (SGA) (1,2,(5)(6)(7)(9)(10)(11).…”

“…To partition the total effect into these component pathways, querying large data sets is necessary. Recently, the authors estimated the total effects of several rheumatic diseases in causing adverse pregnancy and birth outcomes from a retrospective birth cohort of 3 million singleton births in California (2). To extend that work, the objective of this study was to perform a causal mediation analysis to determine the extent to which pregnancy complications (preeclampsia/hypertensive disorder, gestational diabetes mellitus, and infections) mediate the association between selected autoimmune conditions (RA, SLE, psoriasis, and IBD) and adverse pregnancy outcomes (preterm birth, caesarean delivery, and SGA).…”

Association of Maternal Immune Activation during Pregnancy and Neurologic Outcomes in Offspring

“…Rather than pathogens, a common pathway through maternal immune activation (MIA) could in part be the link between maternal infections during pregnancy and neuropsychiatric disorders in the offspring. Case-control studies and meta-analyses have shown that maternal autoimmune disorders are associated with ASD and developmental delay [12][13][14][15][16][17] . One case-control study indicated asthma and allergy to be significantly associated with ASD 18 .…”