Perinatal factors and adult‐onset lupus

Abstract

Objective. Some evidence suggests that perinatal factors, including birth weight and breastfeeding, may influence the occurrence of autoimmune rheumatic diseases. However, few studies have investigated these factors in patients with systemic lupus erythematosus (SLE). Therefore, we evaluated the role of birth weight, being breastfed, and preterm birth on the incidence of SLE in participants in the Nurses' Health Study (NHS) and the Nurses' Health Study II (NHSII). Methods. We studied 87,411 NHS participants and 98,413 NHSII participants without SLE at baseline who provided information on perinatal exposures. Among these women, during 26 (NHS) and 14 (NHSII) years of followup, 222 incident SLE cases were confirmed (136 NHS and 86 NHSII) by medical record review using American College of Rheumatology criteria. We used stratified Cox models to estimate the association of perinatal factors with SLE, adjusting for race, early passive cigarette smoke exposure, and parents' occupation. A random-effects meta-analysis was used to compute combined estimates across the 2 cohorts. Results. After adjustment for multiple potential confounders, high birth weight (>10 pounds) was associated with increased rates of SLE compared with normal birth weight (7-8.5 pounds; rate ratio [RR] 2.7, 95% confidence interval [95% CI] 1.2-5.9), as was being born >2 weeks preterm (RR 1.9, 95% CI 1.2-3.0); however, being breastfed was not (RR 0.8, 95% CI 0.6 -1.1). Conclusion. Birth weight >10 pounds and preterm birth were both positively associated with incident SLE among women.

Onset of polyarticular juvenile idiopathic arthritis with both anti-cyclic citrullinated peptide antibodies and rheumatoid factor in a 3-year-old girl

“…Meanwhile, preterm birth was recently found to be a risk factor for systemic lupus erythematosus and related autoimmune conditions [17]. The immature immune system of a preterm neonate may be ill-suited to long-term alterations to the immune system.…”

Can the Events of Early Life Influence the Development of Rheumatoid Arthritis?

“…The same group has shown an association between high birth weight and a greater risk of developing adult RA in the NHS. Interestingly, they have also shown that higher birth weight was associated with an increased incidence of developing systemic lupus erythematosus in the same cohort 13 . Other groups have shown associations between high birth weight and development of RA 14 , and low birth weight being protective for the development of See Early life factors and adult-onset RA, page 32…”

Increased risk of systemic lupus erythematosus in pregnancy-induced hypertension

“…Simard et al indicated that participants that experienced a preterm birth had a statistically significant, 1.9-fold higher incidence of SLE (95% CI 1.2–3.0). [47] A population-based nested case–control study showed that there was a 2.4-fold increased odd of SLE among males born preterm (95% CI 1.09–5.36). [48] Our multivariate analysis revealed that patients with preterm birth displayed a significant 2.09-fold increased HR for SLE (95% CI 1.42–3.06) (see Table 3).…”