Home Medizin Studie legt nahe, dass schwangere Frauen mit Autoimmunerkrankungen ein höheres Risiko haben, unerwünschte Schwangerschaftsausgänge zu entwickeln

Studie legt nahe, dass schwangere Frauen mit Autoimmunerkrankungen ein höheres Risiko haben, unerwünschte Schwangerschaftsausgänge zu entwickeln

von NFI Redaktion

Researchers recently published a review in BMC Medicine analyzing systematic reviews on the relationship between autoimmune diseases and pregnancy outcomes.


Study: Autoimmune Diseases and Adverse Pregnancy Outcomes: An Overview Review. Image Source: Africa Studio/Shutterstock.com









Study: Autoimmune Diseases and Adverse Pregnancy Outcomes: An Overview Review. Image Source: Africa Studio/Shutterstock.com

Background

Autoimmune diseases, especially in women, have been associated with poor pregnancy outcomes due to environmental variables such as lifestyle changes, diet, and exposure to certain infections and medications. Adverse pregnancy outcomes associated with specific autoimmune diseases can improve, worsen, or remain constant during pregnancy.

Autoimmune diseases can complicate pregnancy by allowing antibodies produced by the mother to penetrate the fetal system and affect the development of the fetal heart. The clinical management of autoimmune pregnancies requires multidisciplinary care and an understanding of the risk of adverse pregnancy outcomes.

About the Review

In the review, researchers analyzed the impact of the prevalence of autoimmune diseases on pregnancy outcomes using systematic reviews to determine the strength and precision of these associations.

The team searched the Cochrane Medline and Embase databases from inception to December 15, 2023, without language restrictions for systematic reviews evaluating the relationship between autoimmune diseases and pregnancy outcomes. They excluded systematic reviews involving women who became pregnant through assisted reproductive therapies and those examining the relationship between medications for autoimmune diseases and pregnancy outcomes. They also excluded literature reviews, scoping reviews, conference summaries, and protocols.

The researchers used the Joanna Briggs Institute (JBI) framework and followed the Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist. Two researchers independently conducted data review and extraction and evaluated the identified records using the Assessment of Multiple Systematic Reviews Version 2 (AMSTAR 2) tool, consulting a third researcher to resolve discrepancies.

The team assessed the quality of systematic reviews using the Newcastle-Ottawa Scale (NOS). They synthesized data quantitatively to estimate relative risks (RRs) and odds ratios (ORs) and performed random-effects modeling for the meta-analysis to obtain pooled effect estimates.

Autoimmune diseases included celiac disease, inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn’s disease, psoriasis conditions (psoriasis and psoriatic arthritis), Sjögren’s syndrome, rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus (SLE), thyroid autoimmunity (Hashimoto’s thyroiditis and Graves‘ disease), vitiligo, and type 1 diabetes mellitus (T1DM).

Results

Initially, the team identified 2,743 records, of which 2,351 underwent title and abstract screening and 92 underwent full-text review after removing duplicates. As a result, they analyzed 32 records, including 709 primary studies, most of which were of moderate to high quality. They found a significant risk of ectopic pregnancy in IBD patients (OR: 1.3), with similar risks for ulcerative colitis and Crohn’s disease.

The team observed an increased risk of miscarriage in women with systemic lupus erythematosus (OR: 4.9) and Sjögren’s syndrome (RR: 8.9), with higher risks in thyroid autoimmune diseases (OR: 2.8). The risk of miscarriage was also significantly 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. Female celiac disease patients had a significantly higher risk of recurrent pregnancy losses (OR: 5.8), which was exacerbated by the presence of thyroid autoimmunity (OR: 1.9).

The likelihood of pregnancy-induced hypertension was higher in women with T1DM, psoriasis, and psoriatic arthritis, with OR values of 2.7, 1.3, and 1.5, respectively, further exacerbated by thyroid autoimmunity (OR 1.3). The team noted a higher prevalence of preeclampsia in women 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 had 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 diseases had a higher risk of postpartum depression (OR: 2.0).

Women with systemic sclerosis and celiac disease had 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) infants were 2.5 for SLE, 1.5 for rheumatoid arthritis, and 0.7 for T1DM patients. The OR values for stillbirths in women with SLE, T1DM, rheumatoid arthritis, celiac disease, and IBD were 17, 4.0, 2.0, 2.0, and 1.6, respectively.

The team found a higher risk of preterm birth in women with T1DM (OR: 4.4), systemic lupus erythematosus (OR: 2.8), systemic sclerosis (OR: 2.4), Sjögren’s syndrome (RR: 2.3), and inflammatory bowel disease (OR: 2.1), rheumatoid arthritis (OR 1.8), psoriatic arthritis (OR 1.5), celiac disease (OR 1.3), and psoriasis (OR 1.2). They reported low birth weight infants in 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 results showed that women with autoimmune diseases are at a high risk of adverse pregnancy outcomes. However, further research is needed to develop evidence-based, standardized recommendations to help doctors and women make informed decisions about managing these diseases before and during pregnancy.

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