Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Int J Epidemiol. 2024 Aug 14;53(5). doi: 10.1093/ije/dyae115.
Autoimmune diseases disproportionately impact women and female-specific aspects of reproduction are thought to play a role. We investigated the time-varying association between pregnancy complications and new-onset autoimmune disease in females during the reproductive and midlife years.
We conducted a population-based cohort study of 1 704 553 singleton births to 1 072 445 females in Ontario, Canada (2002-17) with no pre-existing autoimmune disease. Pregnancy complications were preeclampsia, stillbirth, spontaneous preterm birth and severe small for gestational age (SGA). Royston-Parmar models were used to estimate the time-varying association between pregnancy complications and a composite of 25 autoimmune diseases from date of delivery to date of autoimmune disease diagnosis or censoring at death, loss of health insurance, or 31 March 2021. Models were adjusted for baseline socio-demographics, parity and comorbidities.
At 19 years (median = 10.9 years of follow-up), cumulative incidence of autoimmune disease was 3.1% in those with a pregnancy complication and 2.6% in those without complications. Adjusted hazard ratio (AHR) curves as a function of time since birth were generally L-shaped. Universally, risks were most elevated within the first 3 years after birth [at 1 year: preeclampsia AHR 1.22, 95% confidence interval (CI) 1.09-1.36; stillbirth AHR 1.36, 95% CI 0.99-1.85; spontaneous preterm birth AHR 1.30, 95% CI 1.18-1.44; severe SGA AHR 1.14, 95% CI 0.99-1.31] and plateaued but remained elevated thereafter.
Prior history of pregnancy complications may be an important female-specific risk factor to consider during clinical assessment of females for possible autoimmune disease to facilitate timely detection and treatment.
自身免疫性疾病在女性中的发病率不成比例，女性特有的生殖相关方面被认为与之相关。我们研究了女性在生殖和中年时期妊娠并发症与新发自身免疫性疾病之间的时变关联。
我们对加拿大安大略省 1072445 名女性的 1704553 例单胎分娩进行了一项基于人群的队列研究（2002-17 年），这些女性在研究开始时均无自身免疫性疾病。妊娠并发症包括子痫前期、死胎、自发性早产和严重胎儿生长受限（SGA）。采用 Royston-Parmar 模型估计了从分娩日期到自身免疫性疾病诊断日期或因死亡、丧失医疗保险或 2021 年 3 月 31 日而失访的日期之间，妊娠并发症与 25 种自身免疫性疾病复合结局之间的时变关联。模型调整了基线社会人口统计学、产次和合并症。
在 19 年（中位数=10.9 年的随访期）时，有妊娠并发症的患者自身免疫性疾病的累积发病率为 3.1%，无并发症的患者为 2.6%。调整后的风险比（AHR）曲线作为出生后时间的函数通常呈 L 形。普遍来说，风险在出生后 3 年内最高[1 年时：子痫前期 AHR 为 1.22，95%置信区间（CI）为 1.09-1.36；死胎 AHR 为 1.36，95%CI 为 0.99-1.85；自发性早产 AHR 为 1.30，95%CI 为 1.18-1.44；严重 SGA AHR 为 1.14，95%CI 为 0.99-1.31]，此后趋于平稳但仍处于较高水平。
妊娠并发症史可能是女性自身免疫性疾病临床评估中需要考虑的一个重要的女性特有的危险因素，以促进及时发现和治疗。
