In a recent review published in BMC Medicine, researchers analyzed systematic reviews conducted on the association between autoimmune diseases and pregnancy outcomes.
Study: Autoimmune diseases and adverse pregnancy outcomes: an umbrella review. Image Credit: Africa Studio/Shutterstock.com
Background
Autoimmune diseases, particularly in women, have been associated with poor pregnancy outcomes as a result of environmental variables such as lifestyle changes, dietary changes, and exposure to certain infections and medicines. The unfavorable pregnancy outcomes associated with certain autoimmune disorders might improve, worsen, or remain constant during pregnancy.
Autoimmune diseases can complicate pregnancy by enabling antibodies generated by the mother to infiltrate the fetal system, affecting the development of the fetal heart. Clinical management of autoimmune pregnancies necessitates multidisciplinary care and an appreciation of the risk of adverse pregnancy outcomes.
About the review
In the present review, researchers analyzed the impact of autoimmune disease prevalence on pregnancy outcomes, using systematic reviews to identify the strength and precision of these associations.
The team searched the Cochrane Medline and Embase databases from inception through December 15, 2023, without language restrictions for systematic reviews evaluating the association between autoimmune disorders and pregnancy outcomes. They excluded systematic reviews, including those involving women conceiving through assisted reproduction therapy and those evaluating the relationship between drugs for autoimmune diseases and pregnancy outcomes. They also excluded literature reviews, scoping reviews, conference abstracts, and protocols.
The researchers used the Joanna Briggs Institute (JBI) framework, following the Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist. Two researchers independently performed data screening and extraction and appraised the identified records using the Assessment of Multiple Systematic Reviews Version 2 (AMSTAR 2) tool, consulting a third researcher to resolve discrepancies.
The team evaluated systematic review quality using the Newcastle-Ottawa scale (NOS). They synthesized data quantitatively to estimate relative risks (RRs) and odds ratios (ORs) and performed random effect modeling for meta-analysis to obtain pooled effect estimates.
Autoimmune disorders included celiac disease, inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, psoriatic disorders (psoriasis and psoriatic arthritis), Sjögren’s syndrome, rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus (SLE), thyroid autoimmunity (Hashimoto's thyroiditis and Grave’s disease), vitiligo, and type 1 diabetes mellitus (T1DM).
Results
Initially, the team identified 2,743 records, of which 2,351 underwent title-abstract screening and 92 underwent full-text screening after duplicate removal. As a result, they analyzed 32 records, including 709 primary studies, most of which were of moderate-high quality. They found a significant ectopic pregnancy risk among IBD patients (OR, 1.3), with similar risks for ulcerative colitis and Crohn’s disease.
The team found increased miscarriage risk among females with systemic lupus erythematosus (OR, 4.9) and Sjögren’s syndrome (RR, 8.9), with the risk being higher (OR, 2.8) in the case of thyroid autoimmune conditions. Miscarriage risk was also significantly higher among women with celiac disease, rheumatoid arthritis, systemic sclerosis, and psoriasis, with OR values of 1.4, 1.3, 1.6, and 1.1, respectively. Female celiac disease patients had a significantly higher risk of recurrent gestational losses (OR, 5.8), exacerbated in thyroid autoimmunity presence (OR, 1.9).
Gestational hypertension odds were higher among females with T1DM, psoriasis, and psoriatic arthritis, with OR values of 2.7, 1.3, and 1.5, respectively, enhanced by thyroid autoimmunity (OR, 1.3). The team found higher pre-eclampsia prevalence among females with type 1 diabetes mellitus (OR, 4.2), systemic lupus erythematosus (OR, 3.2), and systemic sclerosis or scleroderma (OR, 2.2). Women with IBD were at an increased risk of gestational diabetes (OR, 3.0). Cesarean section delivery was associated with T1DM (OR, 4.0) and SLE (OR, 2.1). Women with thyroid autoimmune disorders had higher odds of postpartum depression (OR, 2.0).
Women with systemic sclerosis and celiac disease were at a higher risk of intrauterine growth restriction (IUGR), with OR values of 3.2 and 1.7, respectively. The OR values for small for gestational age (SGA) babies were 2.5 for SLE, 1.5 for rheumatoid arthritis, and 0.7 for T1DM patients. The OR values for stillbirth among women with SLE, T1DM, rheumatoid arthritis, celiac disease, and IBD were 17, 4.0, 2.0, 2.0, and 1.6, respectively.
The team noted a higher risk for 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).
Conclusion
Overall, the review findings showed that women with autoimmune disorders are at a high risk of unfavorable pregnancy outcomes. However, further research is required to develop more evidence-based, standardized recommendations and assist physicians and women in making educated decisions about treating these diseases before and throughout pregnancy.
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