Pregnancy Complications and Risk of Autoimmune Disease in Women: A Systematic Review and Meta-Analysis.

IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Natalie V Scime, Andi Camden, Carmela Melina Albanese, Sonia M Grandi, Kathryn Barrett, Hilary K Brown
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引用次数: 0

Abstract

Background: Autoimmune diseases disproportionately impact women, and pregnancy-related events could play an underlying role. We summarized literature on the association between pregnancy complications and future risk of autoimmune disease. Materials and Methods: We systematically searched Medline, EMBASE, CINAHL Plus, and Web of Science from database inception to January 2024 for observational studies that reported on history of pregnancy complications (exposure), risk of newly diagnosed autoimmune disease (outcome), and included a comparison group of unaffected women. Two reviewers independently assessed study eligibility, extracted data, and rated risk of bias. We estimated pooled risk ratios (RRs) or odds ratios (ORs) and 95% confidence intervals (CIs) for pregnancy complications with ≥3 identified studies using DerSimonian and Laird random effects models and otherwise summarized findings following synthesis without meta-analysis (SWiM). Results: We screened 7,763 citations and included 25 studies (12 cohort, 13 case-control). Most studies were from Denmark (n = 10) or the United Kingdom (n = 5), with sample sizes ranging from 138 to >1.5 million women (median = 1,304 women). Risk of bias was moderate, serious, and critical in 10, 13, and 2 studies, respectively, with quality adversely impacted by potential unmeasured confounding. Meta-analyses indicated an elevated risk of autoimmune disease following preeclampsia (adjusted RR: 1.61, 95% CI: 0.98-2.65, I2 = 90.0%) and small fetal/infant size (adjusted OR: 2.02, 95% CI: 1.16-3.52, I2 = 28.4%), and possibly spontaneous pregnancy loss (adjusted RR: 1.58, 95% CI: 0.66-3.79, I2 = 99.4%) and stillbirth (adjusted RR: 2.18, 95% CI: 0.65-7.34, I2 = 99.2%), although estimates were often imprecise. SWiM findings generally supported a positive association between pregnancy complications and autoimmune disease; there were insufficient studies for gestational diabetes, placental disorders, and preterm birth. Conclusions: History of certain pregnancy complications may be a novel risk factor for autoimmune disease in women. Additional high-quality research with geographically diverse data sources would be valuable.

妊娠并发症和女性自身免疫性疾病的风险:系统回顾和荟萃分析
背景:自身免疫性疾病对女性的影响不成比例,妊娠相关事件可能起潜在作用。我们总结了有关妊娠并发症与自身免疫性疾病未来风险之间关系的文献。材料和方法:我们系统地检索了Medline、EMBASE、CINAHL Plus和Web of Science从数据库建立到2024年1月的观察性研究,这些研究报告了妊娠并发症(暴露)史、新诊断的自身免疫性疾病风险(结果),并纳入了一组未受影响的妇女。两名审稿人独立评估研究合格性、提取数据并评定偏倚风险。我们使用DerSimonian和Laird随机效应模型估计了妊娠并发症的合并风险比(rr)或优势比(ORs)和95%置信区间(CIs),并总结了未经荟萃分析(SWiM)的综合结果。结果:我们筛选了7763条引用,纳入了25项研究(12项队列研究,13项病例对照研究)。大多数研究来自丹麦(n = 10)或英国(n = 5),样本量从138万至150万女性(中位数= 1,304名女性)。10项、13项和2项研究的偏倚风险分别为中度、严重和严重,潜在的未测量混杂因素对质量产生不利影响。荟萃分析显示,虽然估计常常不精确,但在子痫前期(校正后的RR: 1.61, 95% CI: 0.98-2.65, I2 = 90.0%)、胎/儿小(校正后的OR: 2.02, 95% CI: 1.16-3.52, I2 = 28.4%)和可能的自然流产(校正后的RR: 1.58, 95% CI: 0.66-3.79, I2 = 99.4%)和死产(校正后的RR: 2.18, 95% CI: 0.65-7.34, I2 = 99.2%)后发生自身免疫性疾病的风险升高。SWiM研究结果普遍支持妊娠并发症与自身免疫性疾病之间的正相关;关于妊娠期糖尿病、胎盘疾病和早产的研究不足。结论:某些妊娠并发症史可能是女性自身免疫性疾病的一个新的危险因素。额外的高质量研究和地理上不同的数据来源将是有价值的。
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来源期刊
Journal of women's health
Journal of women's health 医学-妇产科学
CiteScore
6.60
自引率
5.70%
发文量
197
审稿时长
2 months
期刊介绍: Journal of Women''s Health is the primary source of information for meeting the challenges of providing optimal health care for women throughout their lifespan. The Journal delivers cutting-edge advancements in diagnostic procedures, therapeutic protocols for the management of diseases, and innovative research in gender-based biology that impacts patient care and treatment. Journal of Women’s Health coverage includes: -Internal Medicine Endocrinology- Cardiology- Oncology- Obstetrics/Gynecology- Urogynecology- Psychiatry- Neurology- Nutrition- Sex-Based Biology- Complementary Medicine- Sports Medicine- Surgery- Medical Education- Public Policy.
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