Mediation of Adverse Pregnancy Outcomes in Autoimmune Conditions by Pregnancy Complications: A Mediation Analysis of Autoimmune Conditions and Adverse Pregnancy Outcomes

Autor: Christina D. Chambers, Nichole Nidey, Sky K. Feuer, Kelli K. Ryckman, Rebecca J. Baer, Gretchen Bandoli, Namrata Singh, Jennifer Strouse, Brittney M. Donovan, Laura L. Jelliffe-Pawlowski
Rok vydání: 2019
Předmět:
Reproductive health and childbirth
Low Birth Weight and Health of the Newborn
California
Cohort Studies
0302 clinical medicine
Pregnancy
Infant Mortality
2.1 Biological and endogenous factors
Psychology
Medicine
Aetiology
Pediatric
Obstetrics
Negotiating
Absolute risk reduction
Pregnancy Outcome
Gestational diabetes
Premature birth
Hypertension
Public Health and Health Services
Premature Birth
Female
Cohort study
Adult
medicine.medical_specialty
Adolescent
Clinical Sciences
Lupus
Autoimmune Disease
Article
Preeclampsia
Autoimmune Diseases
03 medical and health sciences
Young Adult
Rheumatology
Preterm
Clinical Research
Humans
Retrospective Studies
030203 arthritis & rheumatology
business.industry
Cesarean Section
Arthritis
Contraception/Reproduction
Prevention
Inflammatory and immune system
Infant
Newborn
Infant
Retrospective cohort study
Perinatal Period - Conditions Originating in Perinatal Period
Newborn
medicine.disease
Pregnancy Complications
Small for gestational age
business
Zdroj: Arthritis Care Res (Hoboken)
Arthritis care & research, vol 72, iss 2
ISSN: 2151-4658
Popis: OBJECTIVE Autoimmune conditions are associated with an increased risk of adverse pregnancy complications and outcomes, suggesting that pregnancy complications may mediate the excess risk. We performed a causal mediation analysis to quantify the mediated effects of autoimmune conditions on adverse pregnancy outcomes. METHODS We queried a California birth cohort created from linked birth certificates and hospital discharge summaries. From 2,963,888 births, we identified women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriasis, and inflammatory bowel disease (IBD). Pregnancy complications included preeclampsia/hypertension, gestational diabetes mellitus, and infection in pregnancy. Adverse pregnancy outcomes were preterm birth, cesarean delivery, and small for gestational age. We performed a mediation analysis to estimate the total effects of each autoimmune condition and adverse pregnancy outcome and the indirect effects through pregnancy complications. RESULTS All 4 autoimmune conditions were associated with preterm birth and cesarean delivery, and RA, SLE, and IBD were associated with offspring that were small for gestational age. The strongest mediator of RA, SLE, and psoriasis was preeclampsia/hypertension, accounting for 20-33% of the excess risk of preterm births and 10-19% of excess cesarean deliveries. Gestational diabetes mellitus and infections generally mediated
Databáze: OpenAIRE
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