Trends in the prevalence of autoimmune diseases during pregnancy in the UK, 2000-21: a retrospective cohort study.

BACKGROUND

Autoimmune diseases are increasingly prevalent worldwide and disproportionately affect women of reproductive age, including during pregnancy. Given the association between autoimmune diseases, comorbidities, and risk factors for adverse pregnancy outcomes, we aimed to estimate the burden of autoimmune disease in pregnancy.

METHODS

This was a UK population-based retrospective cohort study using routinely collected data from two large databases (Clinical Practice Research Datalink Gold and Aurum) and associated pregnancy registers. Prevalence was calculated annually for 17 autoimmune diseases (Addison's disease, alopecia areata, ankylosing spondylitis, coeliac disease, inflammatory bowel disease (including Crohn's disease and ulcerative colitis), Graves' disease, Hashimoto's thyroiditis, multiple sclerosis, myasthenia gravis, psoriasis, psoriatic arthritis, rheumatoid arthritis, Sjögren's disease, SLE, systemic sclerosis, type 1 diabetes, and vitiligo) in pregnancies among women of reproductive age (15-49 years) from Jan 1, 2000, to Dec 31, 2021. Logistic regression was used to estimate odds ratios, describing the relationship between women's characteristics (age, ethnicity, deprivation, BMI, smoking status, and gravidity), comorbidities, and autoimmune diseases. Patient and public involvement and engagement representatives participated in formulating the research question. They also played key role in collaboration with clinicians and researchers to identify and consider the list of autoimmune diseases in the study, and played a key role in disseminating the results.

FINDINGS

5 165 960 pregnancies in 2 831 472 women were included. In 2000-21, there were 185 208 pregnancies in 100 655 women who had a coded diagnosis of autoimmune disease. There was an increase in prevalence of the combination of 17 autoimmune diseases, from 6058 (3·5%) of 172 430 in 2000 to 8429 (4·7%) of 181 532 in 2021. Of the 17 autoimmune diseases studied, psoriasis had the highest prevalence throughout the study period. The prevalence of most of the autoimmune diseases increased from 2000 to 2021. The steepest rise was Hashimoto's thyroiditis, followed by coeliac disease, Grave's disease, and type 1 diabetes. Women in less deprived areas had higher odds of an autoimmune disease during pregnancy (adjusted odds ratio 1·10 [95% CI 1·07-1·14]), whereas minority ethnic groups had lower prevalence rates compared with White women (Black women 0·48 [0·45-0·51]; Asian women 0·81 [0·77-0·85]). Ex-smokers had significantly higher odds of autoimmune disease than non-smokers (1·20 [1·18-1·23]). When compared with women with a single pregnancy, the odds of having an autoimmune disease were significantly higher for women with five or more pregnancies (1·12 [1·10-1·15]). Women with metabolic and mental health conditions had significantly higher odds of having an autoimmune disease during pregnancy (type 2 diabetes, 1·41 [1·30-1·53]; hypertension, 1·07 [1·01-1·13]; anxiety, 1·15 [1·12-1·19]; depression, 1·17 [1·14-1·20]).

INTERPRETATION

The growing burden of autoimmune diseases in pregnancy calls for research into their impact on outcomes. Health policy should address gaps in specialised care to ensure individuals receive evidence-based care to prevent deterioration of the autoimmune disease and development of adverse pregnancy outcomes.

FUNDING

Strategic Priority Fund, Medical Research Council, National Institute for Health and Care Research, Economic and Social Research Council, and Engineering and Physical Sciences Research Council.