Department of Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland.
Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Rheumatology (Oxford). 2024 Oct 1;63(10):2701-2710. doi: 10.1093/rheumatology/keae122.
Rheumatic diseases may impair reproductive success and pregnancy outcomes, but systematic evaluations across diseases are lacking. We conducted a nationwide cohort study to examine the impact of rheumatic diseases on reproductive health measures, comparing the impacts with those of other immune-mediated diseases (IMDs).
Out of all of the 5 339 804 Finnish citizens, individuals born 1964-1984 and diagnosed with any of the 19 IMDs before age 30 (women) or 35 (men) were matched with 20 controls by birth year, sex, and education. We used data from nationwide health registers to study the impact of IMDs on reproductive health measures, such as reproductive success and, for women, ever having experienced adverse maternal and perinatal outcomes.
Several of the rheumatic diseases, particularly SLE, JIA, and seropositive RA, were associated with higher rates of childlessness and fewer children. The risks for pre-eclampsia, newborns being small for gestational age, preterm delivery, non-elective Caesarean sections, and need of neonatal intensive care were increased in many IMDs. Particularly, SLE, SS, type 1 diabetes, and Addison's disease showed >2-fold risks for some of these outcomes. In most rheumatic diseases, moderate (1.1-1.5-fold) risk increases were observed for diverse adverse pregnancy outcomes, with similar effects in IBD, celiac disease, asthma, ITP, and psoriasis.
Rheumatic diseases have a broad impact on reproductive health, with effects comparable with that of several other IMDs. Of the rheumatic diseases, SLE and SS conferred the largest risk increases on perinatal adverse event outcomes.
风湿性疾病可能会影响生殖成功和妊娠结局，但缺乏针对多种疾病的系统评估。我们开展了一项全国性队列研究，旨在检查风湿性疾病对生殖健康指标的影响，并将其与其他免疫介导性疾病（IMD）的影响进行比较。
在所有 5339804 名芬兰公民中，我们选取了 1964 年至 1984 年出生且在 30 岁（女性）或 35 岁（男性）之前被诊断出患有任何一种 IMD 的人群，并按出生年份、性别和教育程度与 20 名对照进行匹配。我们利用全国性健康登记数据来研究 IMD 对生殖健康指标的影响，如生殖成功率，以及女性是否曾经历过不良的母婴和围产期结局。
几种风湿性疾病，特别是系统性红斑狼疮、幼年特发性关节炎和血清阳性类风湿关节炎，与不孕率和子女数量较少相关。许多 IMD 与子痫前期、新生儿出生体重低、早产、非计划性剖宫产和新生儿重症监护的需求增加有关。特别是，系统性红斑狼疮、干燥综合征、1 型糖尿病和艾迪生病在这些结局中表现出超过 2 倍的风险。在大多数风湿性疾病中，我们观察到多种不良妊娠结局的中度（1.1-1.5 倍）风险增加，与炎症性肠病、乳糜泻、哮喘、特发性血小板减少性紫癜和银屑病的影响相似。
风湿性疾病对生殖健康有广泛影响，其影响与其他几种 IMD 相当。在风湿性疾病中，系统性红斑狼疮和干燥综合征对围产期不良事件结局的风险增加最大。
