Preterm birth phenotypes in women with autoimmune rheumatic diseases: a population‐based cohort study

Abstract

Objective To investigate preterm birth (PTB) phenotypes in women with different autoimmune rheumatic diseases in a large population‐based cohort. Design Retrospective cohort study. Setting California, USA. Population All live singleton births in California between 2007 and 2011 were analysed. Patients with autoimmune disease at delivery were identified by International Classification of Diseases, Ninth Revision , Clinical Modification (ICD‐9‐CM), codes for systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), polymyositis/dermatomyositis (DM/PM), and juvenile idiopathic arthritis (JIA). Methods Maternally linked hospital and birth certificate records of 2 481 516 deliveries were assessed (SLE n = 2272, RA n = 1501, SSc n = 88, JIA n = 187, DM/PM n = 38). Multivariable Poisson regression models estimated the risk ratios (RRs) for different PTB phenotypes (relative to term deliveries) for each autoimmune disease compared with the general obstetric population, adjusting for maternal age, race/ethnicity, body mass index, smoking, education, payer, parity, and prenatal care. Main outcome measures Preterm birth (PTB) was assessed overall (20–36 weeks of gestation) and by subphenotype: preterm prelabour rupture of membranes (PPROM), spontaneous birth, or medically indicated PTB. The risk of PTB overall and for each phenotype was partitioned by gestational age: early (20–31 weeks of gestation) and late (32–36 weeks of gestation). Results Risks for PTB were elevated for each autoimmune disease evaluated: SLE (RR 3.27, 95% CI 3.01–3.56), RA (RR 2.04, 95% CI 1.79–2.33), SSc (RR 3.74, 95% CI 2.51–5.58), JIA (RR 2.23, 95% CI 1.54–3.23), and DM/PM (RR 5.26, 95% CI 3.12–8.89). These elevated risks were observed for the majority of PTB phenotypes as well. Conclusions Women with systemic autoimmune diseases appear to have an elevated risk of various PTB phenotypes. Therefore, preconception counselling and close monitoring during pregnancy is crucial. Tweetable abstract This study found that women with systemic autoimmune diseases have an elevated risk of preterm birth phenotypes.

Pregnancy outcomes in women with idiopathic inflammatory myopathy, before and after diagnosis—a population-based study

“…We identified women with IIM from both inpatient and outpatient clinics, and therefore disease activity may have varied from mild to severe, which might explain the difference between our findings and the Australian study although our study did not find any different risk estimates among births to women with IIM identified from the inpatient vs the outpatient register. Besides, Kolstad et al recently found that the risk of early preterm birth (7.9% vs 1.0%, aRR = 10.0; 95% CI: 3.2, 31.1) was particularly high in 38 births of women with DM/PM compared with controls [ 9 ], which is in line with our findings. Two previous studies including women with IIM prior to pregnancy also observed lower mean birth weight among cases with active IIM compared with cases with inactive IIM [ 4 , 28 ].…”

Retrospective cohort study of pregnancy outcomes in hidradenitis suppurativa

“…Prior studies on other inflammatory diseases such as rheumatoid arthritis and systemic lupus erythematosus have shown that the disease influences rates of preterm birth and pregnancy loss. 2 No statistically significant differences were detected when comparing our study cohort with the general population of women in the US in terms of the rates of miscarriage, 3 C-section, 4 premature baby, 4 stillbirth 5 and perinatal mortality. 5 In addition, baseline HS disease severity was not significantly associated with poorer pregnancy or neonatal outcomes.…”

“…1 The National Institute for Health and Care Excellence recommends specialist review if cellulitis has not improved after 14 days despite antibiotics. 2 The 2017 Cellulitis Priority Setting Partnership prioritized research into diagnosis and treatment of cellulitis. 3 Cellulitis diagnosis is based on history, examination and inflammatory markers.…”

Chronic histiocytic intervillositis: A breakdown in immune tolerance comparable to allograft rejection?

“…42 The extent and timing of this cytokine cascade inevitably requires precise control, as excess inflammation (ie generated by autoimmune disease) may instigate early-onset delivery as epitomized in preterm labour. 33,43,44…”