Plowden Torie C, Connell Matthew T, Hill Micah J, Mendola Pauline, Kim Keewan, Nobles Carrie J, Kuhr Daniel L, Galai Noya, Gibbins Karen J, Silver Robert M, Wilcox Brian, Sjaarda Lindsey, Perkins Neil J, Schisterman Enrique F, Mumford Sunni L
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. MSC 7004, Bethesda, MD 20892, United States.
Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 10 Center Drive, Bethesda, MD 20892, United States.
J Transl Autoimmun. 2020 Jun 1;3:100059. doi: 10.1016/j.jtauto.2020.100059. eCollection 2020.
Several autoimmune conditions have adverse effects on reproductive outcomes, but the relationship between family history of autoimmune disease in women without these conditions and pregnancy is uncertain. The objective of this study was to determine if there is an association between a family history of an autoimmune condition and time-to-pregnancy (TTP), pregnancy loss, and live birth. This was a prospective cohort study from a RCT of 1228 adult women ages 18-40, who were healthy, had no history of infertility, were actively attempting to conceive, and had one or two prior pregnancy losses. Of these, 1172 women had data available regarding family history of autoimmune conditions. Women with an affected first-degree relative had similar TTP when compared to those without a FHx (fecundability odds ratio 0.90, 95% confidence interval [CI] 0.70, 1.15). Women with an affected first-degree relative had a lower likelihood of live birth (relative risk [RR] 0.83, 95% CI 0.69, 0.99). Among women who achieved pregnancy, FHx of autoimmune disease was associated with a higher likelihood of pregnancy loss (RR 1.49, 95% CI 1.10, 2.03). Women who had a first-degree relative with an autoimmune disease had a similar TTP as unaffected women but a lower likelihood of live birth and higher risk of pregnancy loss. This information may encourage clinicians to evaluate women with a family history of autoimmune conditions prior to pregnancy and highlights the need for further studies to ascertain the effects of autoimmunity and pregnancy.
几种自身免疫性疾病会对生殖结局产生不良影响，但对于没有这些疾病的女性，自身免疫性疾病家族史与妊娠之间的关系尚不确定。本研究的目的是确定自身免疫性疾病家族史与受孕时间（TTP）、流产和活产之间是否存在关联。这是一项前瞻性队列研究，来自一项随机对照试验，该试验纳入了1228名年龄在18至40岁之间的成年女性，她们身体健康，无不孕史，正在积极尝试受孕，且有一或两次既往流产史。其中，1172名女性有关于自身免疫性疾病家族史的数据。与没有家族史（FHx）的女性相比，有一级亲属患自身免疫性疾病的女性受孕时间相似（受孕几率比为0.90，95%置信区间[CI]为0.70，1.15）。有一级亲属患自身免疫性疾病的女性活产的可能性较低（相对风险[RR]为0.83，95%CI为0.69，0.99）。在成功受孕的女性中，自身免疫性疾病家族史与流产的可能性较高有关（RR为1.49，95%CI为1.10，2.03）。有一级亲属患自身免疫性疾病的女性与未受影响的女性受孕时间相似，但活产的可能性较低，流产风险较高。这些信息可能会促使临床医生在女性怀孕前对有自身免疫性疾病家族史的女性进行评估，并突出了进一步研究以确定自身免疫与妊娠影响的必要性。
