ADVERSE pregnancy outcomes are more often noticed in patients with immune-mediated disease (IMD), says Anne M. Kerola, University of Helsinki, Finland, and team, underscoring the challenge in providing evidence-based guidelines for family planning and pregnancy management.
To understand the impact of IMD on reproductive health, Kerola and colleagues analysed 32 years of births in Finland, using data from a nationwide registry of Finnish citizens. The research involved a vast cohort of 5,339,804 people, and examined how 19 immune-mediated conditions, such as juvenile idiopathic arthritis, psoriatic arthritis, rheumatoid arthritis, and systemic lupus erythematosus impact reproductive success, as well as maternal and perinatal outcomes.
Individuals born between 1964–1984, diagnosed with an IMD before age 30 years for females or 35 for males, were matched with 20 controls by sex, birth year, and education level. Regression models estimated effect sizes, with a sensitivity analysis adjusting for pre-pregnancy BMI regarding gestational diabetes, and pre-eclampsia or eclampsia. Follow-up lasted until 31st December 2019, or the patient’s demise.
The team noted that the majority of rheumatic diseases examined in the research displayed a heightened risk, ranging from 1.1–1.5-times higher, for various adverse pregnancy outcomes. Patients with rheumatoid arthritis and juvenile idiopathic arthritis showed elevated rates of childlessness and a reduced number of children, compared to the control group. The researchers noted that many IMDs had minimal or no effect on the prevalence of childlessness, and most had little or no impact on the number of children.
They observed variations in effect sizes among different rheumatic diseases, with rheumatoid arthritis, juvenile idiopathic arthritis, and systemic lupus erythematosus showing significant effects on reproductive success. The team highlighted the absence of recommendations for monitoring and treating pregnant females with certain IMDs, underscoring the importance of awareness of associated risks in developing such recommendations. They further emphasised the necessity of early and regular discussions about family planning in females of reproductive age with rheumatic diseases to inform recommendations for pregnancy monitoring.
Reference
Kerola AM et al. Patterns of reproductive health in inflammatory rheumatic diseases and other immune-mediated diseases: a nationwide registry study. Rheumatology (Oxford). 2024;DOI:10.1093/rheumatology/keae122.
