In a recent examination published in BMC Medicine, researchers conducted a thorough analysis of systematic reviews that further corroborated the risk of adverse pregnancy outcomes, including preterm birth, stillbirth, and low birth weight, in pregnant women with autoimmune conditions. Autoimmune diseases can affect fetal heart development during pregnancy. Proper clinical management necessitates a multidisciplinary approach and an understanding of potential risks.
The study conducted by Singh et al. screened 2,351 through title-abstract and 92 through full-text screening. Analyzing 32 records and 709 primary studies, they found a significant ectopic pregnancy risk in IBD patients (OR, 1.3), with similar risks for ulcerative colitis and Crohn’s disease. Increased miscarriage risk was noted in females with systemic lupus erythematosus (OR, 4.9) and Sjögren’s syndrome (RR, 8.9), higher (OR, 2.8) with thyroid autoimmune conditions. Miscarriage risk was also higher in women with celiac disease, rheumatoid arthritis, systemic sclerosis, and psoriasis, with OR values of 1.4, 1.3, 1.6, and 1.1, respectively. Celiac disease patients had a significantly higher risk of recurrent gestational losses (OR, 5.8), which exacerbated in the presence of thyroid autoimmunity (OR, 1.9).
In females, gestational hypertension odds were significantly elevated in those with T1DM, psoriasis, and psoriatic arthritis, with corresponding OR values of 2.7, 1.3, and 1.5, respectively. This risk was further increased in patients with thyroid autoimmunity (OR, 1.3). Additionally, a higher prevalence of pre-eclampsia was observed in females with type 1 diabetes mellitus (OR, 4.2), systemic lupus erythematosus (OR, 3.2), and systemic sclerosis or scleroderma (OR, 2.2). Inflammatory bowel disease (IBD) was associated with an increased risk of gestational diabetes (OR, 3.0). Cesarean section delivery was significantly associated with T1DM (OR, 4.0) and systemic lupus erythematosus (OR, 2.1). Furthermore, women with thyroid autoimmune disorders had higher odds of experiencing postpartum depression (OR, 2.0). Those with systemic sclerosis and celiac disease were at elevated risk of intrauterine growth restriction (IUGR), with OR values of 3.2 and 1.7, respectively. The odds ratios for small for gestational age (SGA) babies were 2.5 for systemic lupus erythematosus, 1.5 for rheumatoid arthritis, and 0.7 for T1DM patients. Lastly, the odds ratios for stillbirth among women with systemic lupus erythematosus, T1DM, rheumatoid arthritis, celiac disease, and IBD were 17, 4.0, 2.0, 2.0, and 1.6, respectively.
The researchers noted a higher risk of preterm birth among women with T1DM (OR, 4.4), systemic lupus erythematosus (OR, 2.8), systemic sclerosis (OR, 2.4), Sjögren’s syndrome (RR, 2.3), inflammatory bowel disease (OR, 1.8), rheumatoid arthritis (OR, 1.6), psoriatic arthritis (OR, 1.5), celiac disease (OR, 1.3), and psoriasis (OR, 1.2). They reported low-birth-weight babies among women with SLE (OR, 6.0) and systemic sclerosis (OR, 3.8). Neonatal mortality was associated with SLE (OR, 8.3), T1DM (OR, 2.3), and Sjögren’s syndrome (OR, 1.8).
The researchers emphasize the elevated risk of negative pregnancy outcomes among women with autoimmune conditions. They underscore the necessity for more comprehensive research aimed at refining pre- and postnatal care strategies tailored to this specific population. By further understanding and addressing the unique challenges faced by pregnant women with autoimmune disorders, healthcare providers can strive to optimize maternal and fetal health outcomes.
Reference
Singh M, Wambua S, Lee SI, Okoth K, Wang Z, Fayaz FFA, et al. Autoimmune diseases and adverse pregnancy outcomes: an umbrella review. BMC Medicine. 2024 Mar 5;22(1):94.