Study challenges prevailing wisdom and reveals nuances

For many expectant mothers with an autoimmune disease, pregnancy can be intimidating and full of unknowns. In some cases, those with specific autoimmune diseases have chosen to forgo pregnancy altogether due to concerns about the treatment of their disease and adverse pregnancy outcomes.

In a study published in the journal eMedicineClinical, researchers from the Institute for Systems Biology (ISB) and Providence have shown nuanced pregnancy outcomes for pregnant women with autoimmune disease. The results reinforce the idea that there is no one-size-fits-all approach and open important new avenues for further investigation.

“Research is progressing rapidly. If you are living with an autoimmune disease and are currently pregnant or planning to have a baby, I highly recommend talking to your autoimmune disease specialist about pregnancy and the many factors to consider consideration regarding your treatment and other important decisions,” said Philip Mease, MD, a rheumatology expert in Providence and a member of the study team.

The research team examined the electronic health records of more than 365,000 pregnant people over a 10-year period, including more than 5,700 patients with at least one of 12 autoimmune diseases: psoriasis, inflammatory disease of the intestine, rheumatoid arthritis, spondyloarthritis, multiple sclerosis, systemic lupus erythematosus, psoriatic arthritis, antiphospholipid syndrome, Sjögren’s syndrome, vasculitis, sarcoidosis and systemic sclerosis.

Researchers took into account a large number of pregnancy and maternal characteristics associated with premature birth, as well as many other medical conditions, such as hypertension and diabetes. Their findings establish a complex relationship between autoimmune diseases and pregnancy outcomes.

In particular, for pregnancies after 20 weeks of gestational age:

• In patients with autoimmune disease, the presence of other pathologies constitutes an important risk factor for premature delivery, small for gestational age and low birth weight.
• Adjusting for other medical conditions reinforced that lupus patients are at higher risk for adverse pregnancy outcomes.
• Unexpectedly, after adjusting for comorbidities, patients with rheumatoid arthritis or inflammatory bowel disease did not have a significantly higher risk of adverse pregnancy outcomes.

“A blanket statement that ‘autoimmune diseases pose a high risk of pregnancy’ is not sufficient. Each type of autoimmune disease is different, each person has their own medical history, and the risk can change over the course of pregnancy. This study highlights the importance of considering comorbidities,” said ISB Associate Professor Jennifer Hadlock, MD, who led the study.

“It was unexpected to find that during pregnancy after 20 weeks of gestation, rheumatoid arthritis and inflammatory bowel disease were not necessarily associated with an increased risk of preterm birth. This raises new questions about the interconnections between comorbidities and autoimmune diseases.”

There is a significant need for prospective studies that examine the duration of pregnancy and include more detail on the severity and management of autoimmune diseases and other concomitant medical problems.

“These findings may help reshape discussions around autoimmune diseases and pregnancy, and bring a new perspective to a traditionally understudied area of ​​research,” Hadlock said.

Provided by the Institute for Systems Biology