Lupus, systemic sclerosis more than double risk for some adverse pregnancy outcomes
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Key takeaways:
- Immune-mediated diseases increased pregnancy risks, highlighting the need for proactive family planning.
- RA, JIA and SLE impacted reproductive success, while SLE and SSc drove adverse outcomes.
Patients with immune-mediated diseases have higher rates of adverse pregnancy outcomes such as preeclampsia and pre-term delivery, with lupus and systemic sclerosis conferring the largest risks, according to data published in Rheumatology.
“Many studies on reproductive health in [immune-mediated diseases (IMDs)] are characterized by small sample sizes, with less systematic data available on unselected patient populations, few comparative studies across different IMDs, and even fewer looking at both women and men,” Anne M. Kerola, MD, PhD, of the University of Helsinki, and colleagues wrote. “Family planning and pregnancy represent a clinical challenge for health care professionals treating patients with IMDs, but lack of high-quality data has limited the availability of evidence-based recommendations in the guidelines.”
To determine the impact of immune-mediated diseases on reproductive health, Kerola and colleagues analyzed the past 32 years of births in Finland using data from a nationwide registry of Finnish citizens. The study included 5,339,804 individuals and compared the effects of 19 immune-mediated diseases — including juvenile idiopathic arthritis, psoriatic arthritis, rheumatoid arthritis, systemic lupus erythematosus and SSc — on reproductive success and maternal and perinatal outcomes.
Individuals born between 1964 and 1984 who were diagnosed with an immune-mediated disease before age 30 years for women, or 35 years for men, were each matched with 20 controls based on sex, birth year and education level. Regression models were used to estimate effect sizes, and a sensitivity analysis adjusted for pre-pregnancy BMI was performed for gestational diabetes and preeclampsia or eclampsia. The follow-up period ran until Dec. 31, 2019, or until death of the patient with an immune-mediated disease.
According to the researchers, SLE was associated with greater than two-fold risk for admission to the neonatal ICU (OR = 2.46; 95% CI, 1.99-3.06), preeclampsia or eclampsia after adjusting for BMI (OR = 3.09; 95% CI, 2.13-4.5), and preterm delivery (OR = 2.84; 95% CI, 2.22-3.64). Meanwhile, SSc was linked to 2.64 times the risk for preterm delivery (95% CI, 2-3.48).
Most of the rheumatic diseases included in the study showed a 1.1- to 1.5-fold increased risk for a range of adverse pregnancy outcomes, Kerola and colleagues added.
In addition, RA, JIA and SLE in both men and women were each associated with increased childlessness and fewer children compared with controls. That said, “many” immune-mediated diseases demonstrated “little or no” impact on the prevalence childlessness, and “most” had “little or no impact on the number of children,” the researchers wrote.
“Variability in effect sizes was observed between individual rheumatic diseases, with largest effects on reproductive success being observed in RA, JIA and SLE, and on pregnancy outcomes in SLE and SSc,” Kerola and colleagues wrote. “While recommendations for monitoring and treatment of pregnant women with some IMDs exist, they are lacking for others. Therefore, awareness of the risks, even if small, may help in the development of such recommendations.
“Considering the widespread impact of rheumatic diseases on reproductive health, our results emphasize the recommendation to discuss family planning early and often in women of reproductive age who have rheumatic diseases and may aid in forming recommendations for pregnancy monitoring in women with rheumatic diseases,” they added.
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