University of California, San Diego.
University of Iowa Hospitals and Clinics and Iowa City Veteran's Administration Medical Center, Iowa City.
Arthritis Care Res (Hoboken). 2020 Feb;72(2):256-264. doi: 10.1002/acr.24037. Epub 2020 Jan 9.
Autoimmune conditions are associated with an increased risk of adverse pregnancy complications and outcomes, suggesting that pregnancy complications may mediate the excess risk. We performed a causal mediation analysis to quantify the mediated effects of autoimmune conditions on adverse pregnancy outcomes.
We queried a California birth cohort created from linked birth certificates and hospital discharge summaries. From 2,963,888 births, we identified women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriasis, and inflammatory bowel disease (IBD). Pregnancy complications included preeclampsia/hypertension, gestational diabetes mellitus, and infection in pregnancy. Adverse pregnancy outcomes were preterm birth, cesarean delivery, and small for gestational age. We performed a mediation analysis to estimate the total effects of each autoimmune condition and adverse pregnancy outcome and the indirect effects through pregnancy complications.
All 4 autoimmune conditions were associated with preterm birth and cesarean delivery, and RA, SLE, and IBD were associated with offspring that were small for gestational age. The strongest mediator of RA, SLE, and psoriasis was preeclampsia/hypertension, accounting for 20-33% of the excess risk of preterm births and 10-19% of excess cesarean deliveries. Gestational diabetes mellitus and infections generally mediated <10% of excess adverse pregnancy outcomes. Of the 4 autoimmune conditions, selected pregnancy complications mediated the least number of adverse pregnancy outcomes among women with IBD.
We found evidence that some excess risk of adverse pregnancy outcomes is mediated through pregnancy complications, particularly preeclampsia/hypertension. Quantifying excess risk and associated pathways provides insight into the underlying etiologies of adverse pregnancy outcomes and can inform intervention strategies.
自身免疫性疾病与不良妊娠并发症和结局的风险增加相关，这表明妊娠并发症可能介导了这种风险的增加。我们进行了因果中介分析，以量化自身免疫性疾病对不良妊娠结局的中介效应。
我们从加利福尼亚州的出生队列中进行了查询，该队列由链接的出生证明和住院记录摘要创建。在 2963888 例分娩中，我们确定了患有类风湿关节炎（RA）、系统性红斑狼疮（SLE）、银屑病和炎症性肠病（IBD）的女性。妊娠并发症包括子痫前期/高血压、妊娠糖尿病和妊娠感染。不良妊娠结局包括早产、剖宫产和胎儿生长受限。我们进行了中介分析，以估计每种自身免疫性疾病和不良妊娠结局的总效应，以及通过妊娠并发症的间接效应。
所有 4 种自身免疫性疾病均与早产和剖宫产相关，RA、SLE 和 IBD 与胎儿生长受限相关。RA、SLE 和银屑病最强的中介因素是子痫前期/高血压，占早产和剖宫产风险增加的 20-33%和 10-19%。妊娠糖尿病和感染通常介导不良妊娠结局的增加不足 10%。在这 4 种自身免疫性疾病中，IBD 患者中选择的妊娠并发症对不良妊娠结局的介导作用最小。
我们发现一些不良妊娠结局的风险增加是通过妊娠并发症介导的，尤其是子痫前期/高血压。量化过剩风险和相关途径为不良妊娠结局的潜在病因提供了深入了解，并为干预策略提供了信息。
