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

Bandoli, Gretchen; Singh, Namrata; Strouse, Jennifer; Baer, Rebecca J.; Donovan, Brittney M.; Feuer, Sky K.; Nidey, Nichole; Ryckman, Kelli K.; Jelliffe‐Pawlowski, Laura L.; Chambers, Christina D.

doi:10.1002/acr.24037

Cited by 31 publications

(23 citation statements)

References 32 publications

(47 reference statements)

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“…The percent of first pregnancies affected by these outcomes in sarcoidosis are similar to those reported in inflammatory arthritis and inflammatory bowel disease in Sweden (5–6% preeclampsia, 8–11% preterm birth, 26–29% cesarean delivery) [ 3 , 25 , 26 ]. These highly intertwined outcomes have multiple causes which are difficult to disentangle in small samples [ 27 ]. Pregnancy involves a complex process of dynamic immune regulation, with an anti-inflammatory stage in the 2nd trimester and later a switch to a pro-inflammatory environment needed to initiate labor [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Maternal and infant outcomes in sarcoidosis pregnancy: a Swedish population-based cohort study of first births

et al. 2020

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Background It is unclear whether sarcoidosis, a multisystem inflammatory disease, is associated with adverse pregnancy outcomes. We aimed to assess the risk of adverse maternal and infant outcomes in sarcoidosis pregnancies, focused on first births. Methods Using a population-based cohort study design and Swedish national registers (2002–2013), we identified 182 singleton first pregnancies in the Medical Birth Register with at least two maternal ICD-coded sarcoidosis visits prior to pregnancy in the National Patient Register. Modified Poisson regression models estimated relative risks (RR) of adverse outcomes in sarcoidosis pregnancies compared to the general population adjusted for maternal age at delivery, calendar year and educational level. Some models were additionally adjusted for maternal body mass index and smoking status. Results The prevalence of pre-existing diabetes and hypertension was higher in mothers with sarcoidosis than those without sarcoidosis. Mothers with sarcoidosis had an increased risk of preeclampsia/eclampsia (RR 1.6; 95%CI 1.0, 2.6) and cesarean delivery (RR 1.3; 95%CI 1.0, 1.6). There were < 5 stillbirths and cases of infection and no cases of placental abruption, venous thromboembolism, cardiac arrest or maternal death. Newborns of first-time mothers with sarcoidosis had a 70% increased risk of preterm birth (RR 1.7; 95%CI 1.1, 2.5). There was an increased risk of birth defects (RR 1.6; 95%CI 0.9, 2.8) the majority of which were non-cardiac. Conclusions Sarcoidosis is associated with increased risks for preeclampsia/eclampsia, cesarean delivery, preterm birth and some birth defects. Awareness of these conditions may prevent possible pregnancy complications in mothers with sarcoidosis and their newborns.

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Section: Discussionmentioning

confidence: 99%

Maternal and infant outcomes in sarcoidosis pregnancy: a Swedish population-based cohort study of first births

et al. 2020

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“…Previous reports reveal that the APOs in SLE patients exceed that of the general population: SLE flare during pregnancy: 21.4%–64%, gestational hypertension: 0.99%–45%, gestational diabetes mellitus: 0%–11%, preeclampsia: 5.4%–20.2%, HELLP syndrome: 0.3%–0.66%, preterm birth: 9%–56%, spontaneous abortion: 0.4%–25%, SGA: 10%–28.5%, Apgar score less than 7 at 1 min: 1%–18% 3,4,8,19–26,28–49 We summarized the frequency of each APO in Table 5.…”

Section: Discussionmentioning

confidence: 97%

Risk of adverse pregnancy outcomes in Japanese systemic lupus erythematosus patients with prior severe organ manifestations: A single-center retrospective analysis

Nakai

Kitada

Fukui

et al. 2021

Lupus

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Background Systemic lupus erythematosus (SLE) increases the incidence of adverse pregnancy outcomes (APOs). Nevertheless, most of the data on SLE pregnancies were derived from database studies in which details of the pregnancies were unavailable, and no consensus exists on the risk of APO in patients with prior severe organ manifestations. Methods SLE patients followed by rheumatologists and gynecologists throughout pregnancy at our institute were retrospectively identified, and their data between April 2003 and December 2020 were reviewed from electronic records. We assigned patients based on the presence of prior severe organ manifestation (renal/neurological manifestation, prior treatment with methylprednisolone pulse therapy/prednisolone 1 mg/kg/day/biological or cytotoxic therapy) and compared the incidence of overall and serious APO (maternal death, pregnancy loss, preterm birth <32 weeks, birthweight <1500 g, Apgar score <7 at 5 min and birth defect). Results This study included 34 pregnancies in 32 patients; 23 pregnancies in 22 patients were classified as SLE with prior severe organ manifestation. There was no statistical difference in the incidence of overall APO between the two groups (52.2% vs 45.5%, P = 1). Among patients with prior severe organ manifestation, 17.4% had serious APO. A detailed electronic health record search revealed specific causes of APO in all pregnancies with serious APO, except the presence of prior severe organ manifestation. Conclusion The incidence of overall APO in SLE patients was not affected by prior severe organ manifestation. Although the incidence of serious APOs increased in patients with previous severe organ manifestation, there were other risk factors for poor pregnancy outcomes besides prior lupus severity. Therefore, proper management by rheumatologists and gynecologists may enable patients with prior severe organ manifestation to safely deliver healthy babies.

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“…15,16 Diseases that may negatively affect pregnancy outcomes, such as obesity, gestational diabetes, hypertension/ preeclampsia, and polycystic ovary syndrome, are more common in patients with PsO. 13,14,[16][17][18] In addition, women with PsO are more likely to smoke and are less likely to take preconception vitamin supplements. 16 Therefore, the management of pregnancy in patients with PsO may require a multidisciplinary approach, especially in patients with moderate-to-severe psoriasis.…”

Section: The Effect Of Pso On Pregnancymentioning

confidence: 99%

“…27 Transport of IgGs varies throughout pregnancy, 28,29 and there is no active IgG transport in the first trimester, merely low levels of passive diffusion. 25 Active transport begins as early as 13 weeks of gestation, and fetal levels in the second trimester (weeks [17][18][19][20][21][22] are approximately 5% to 10% of maternal levels. 25 This level rises in the third trimester to reach approximately 50% of maternal levels by weeks 28 to 32, eventually increasing to 20% to 30% above maternal levels at birth.…”

Section: Transplacental Transfermentioning

confidence: 99%

Management of Plaque Psoriasis With Biologic Therapies in Women of Child-Bearing Potential Consensus Paper

et al. 2020

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Background Plaque psoriasis (PsO) is a chronic inflammatory disease that often presents at peak reproductive age in women of child-bearing potential (WOCBP). With the emergence of biologic therapies to treat PsO, guidance on disease management in WOCBP is needed to inform treatment decisions before, during, and after pregnancy. Objectives To develop a practical, up-to-date consensus document, based on available evidence and expert opinion where evidence was lacking, in order to guide both Canadian and international clinicians treating PsO in WOCBP. Methods A panel of 9 Canadian dermatologists with extensive clinical experience managing PsO reviewed the relevant literature from the past 25 years in 3 key domains: overview of PsO in WOCBP and clinical considerations, treatment considerations, and postpartum considerations. The structured literature search focused on WOCBP treated with TNF-alpha inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), IL-12/23 inhibitors (ustekinumab), and IL-17 inhibitors (brodalumab, ixekizumab, secukinumab). This literature review, along with clinical expertise and opinion, was used to develop concise and clinically relevant consensus statements to guide practical management of PsO in WOCBP. Experts voted on the statements using a modified Delphi process and prespecified agreement cut-off of 75%. Results and implications After review, discussion, and voting on 19 draft consensus statements at an in-person meeting and remotely, 12 consensus statements were approved by the expert panel. The statements presented here will guide healthcare providers in practical disease management using biologic therapies for the treatment of PsO in WOCBP.

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

Cited by 31 publications

References 32 publications

Maternal and infant outcomes in sarcoidosis pregnancy: a Swedish population-based cohort study of first births

Maternal and infant outcomes in sarcoidosis pregnancy: a Swedish population-based cohort study of first births

Risk of adverse pregnancy outcomes in Japanese systemic lupus erythematosus patients with prior severe organ manifestations: A single-center retrospective analysis

Management of Plaque Psoriasis With Biologic Therapies in Women of Child-Bearing Potential Consensus Paper

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