Department of Epidemiology Research, Statens Serum Institut, Copenhagen S, Denmark.
J Autoimmun. 2012 May;38(2-3):J81-7. doi: 10.1016/j.jaut.2011.06.004. Epub 2011 Aug 2.
To evaluate the possible biological role of pregnancy on the risk of autoimmune diseases we assessed associations between reproductive history and subsequent risk of autoimmune diseases characterized by female predominance and other autoimmune diseases. Our study cohort comprised 4.6 million Danes born since 1935 for whom a complete record of childbirths was available. Cohort members were followed for hospital contacts for 31 autoimmune diseases from 1982 to 2008. Female predominant autoimmune diseases were those with a female:male sex ratio >2:1. Ratios of first hospitalization rates were calculated using Poisson regression, adjusting for potential confounding by age, birth cohort, calendar period and marital status. During 45.5 million person-years of follow-up 102,260 women were hospitalized with one or more autoimmune diseases. Overall, compared with childless women, women with children were at a relative risk of 1.04 (1.02-1.06) for any autoimmune diseases, 1.11 (1.08-1.14) for female predominant and 0.97 (0.95-1.00) for other autoimmune diseases. Possibly biologically related associations with parity were found for Hashimoto thyroiditis (1.11; 1.00-1.24), Graves' disease (1.19; 1.14-1.24), erythema nodosum (1.15; 1.01-1.32), psoriasis (1.08; 1.01-1.15), sarcoidosis (1.17; 1.06-1.28) and systemic lupus erythematosus (0.83; 0.74-0.93). Especially the one-year postpartum period was associated with an increased risk of Hashimoto thyroiditis, Graves' disease and sarcoidosis. Overall, parity was associated with an 11% increased risk of female predominant autoimmune diseases. Pregnancies resulting in liveborn children therefore seem to contribute only little to the general female predominance in autoimmune diseases. However, for a number of autoimmune diseases; especially autoimmune thyroid diseases, erythema nodosum and sarcoidosis parity might somehow be involved in disease development.
为了评估妊娠对自身免疫性疾病风险的可能生物学作用，我们评估了生育史与随后发生的以女性为主的自身免疫性疾病和其他自身免疫性疾病之间的关联。我们的研究队列包括自 1935 年以来出生的 460 万丹麦人，他们的分娩记录完整。队列成员在 1982 年至 2008 年期间因 31 种自身免疫性疾病住院。以女性为主的自身免疫性疾病是指女性与男性的性别比例>2:1 的疾病。使用泊松回归计算首次住院率比值，调整年龄、出生队列、日历时间和婚姻状况的潜在混杂因素。在 4550 万人年的随访期间，有 102260 名女性因一种或多种自身免疫性疾病住院。总体而言，与无子女的女性相比，有子女的女性患任何自身免疫性疾病的相对风险为 1.04（1.02-1.06），以女性为主的自身免疫性疾病为 1.11（1.08-1.14），其他自身免疫性疾病为 0.97（0.95-1.00）。与产次可能存在生物学相关的关联包括桥本甲状腺炎（1.11；1.00-1.24）、格雷夫斯病（1.19；1.14-1.24）、结节性红斑（1.15；1.01-1.32）、银屑病（1.08；1.01-1.15）、结节病（1.17；1.06-1.28）和系统性红斑狼疮（0.83；0.74-0.93）。特别是产后一年与桥本甲状腺炎、格雷夫斯病和结节病的风险增加有关。总的来说，产次与以女性为主的自身免疫性疾病的风险增加 11%有关。因此，导致活产的妊娠似乎只对女性在自身免疫性疾病中的普遍优势贡献很小。然而，对于一些自身免疫性疾病，特别是自身免疫性甲状腺疾病、结节性红斑和结节病，产次可能以某种方式参与疾病的发展。
