Preterm birth phenotypes in women with autoimmune rheumatic diseases: a population‐based cohort study

Objective To investigate preterm birth (PTB) phenotypes in women with different autoimmune rheumatic diseases in a large population‐based cohort. Design Retrospective cohort study. Setting California, USA. Population All live singleton births in California between 2007 and 2011 were analysed. Patien...

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Published in:	BJOG : an international journal of obstetrics and gynaecology Vol. 127; no. 1; pp. 70 - 78
Main Authors:	Kolstad, KD, Mayo, JA, Chung, L, Chaichian, Y, Kelly, VM, Druzin, M, Stevenson, DK, Shaw, GM, Simard, JF
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-01-2020
Subjects:	Adult Arthritis Autoimmune disease Autoimmune diseases Autoimmune Diseases - epidemiology Birth Body mass index California - epidemiology Cohort analysis connective tissue disease Dermatomyositis Disease eclampsia Female Gestational Age Health risk assessment Humans Parity Phenotype Phenotypes Polymyositis Population Population studies Population-based studies Pre-Eclampsia - epidemiology Preeclampsia Pregnancy Pregnancy Complications - epidemiology Premature birth Premature Birth - epidemiology preterm birth preterm prelabour rupture of membranes pre‐eclampsia Regression analysis Retrospective Studies Rheumatic diseases Rheumatic Diseases - epidemiology Rheumatoid arthritis Risk Factors Systemic lupus erythematosus Systemic sclerosis Womens health California United States > US preterm birth Autoimmune disease eclampsia pre-eclampsia preterm prelabour rupture of membranes connective tissue disease
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Summary:	Objective To investigate preterm birth (PTB) phenotypes in women with different autoimmune rheumatic diseases in a large population‐based cohort. Design Retrospective cohort study. Setting California, USA. Population All live singleton births in California between 2007 and 2011 were analysed. Patients with autoimmune disease at delivery were identified by International Classification of Diseases, Ninth Revision , Clinical Modification (ICD‐9‐CM), codes for systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), polymyositis/dermatomyositis (DM/PM), and juvenile idiopathic arthritis (JIA). Methods Maternally linked hospital and birth certificate records of 2 481 516 deliveries were assessed (SLE n = 2272, RA n = 1501, SSc n = 88, JIA n = 187, DM/PM n = 38). Multivariable Poisson regression models estimated the risk ratios (RRs) for different PTB phenotypes (relative to term deliveries) for each autoimmune disease compared with the general obstetric population, adjusting for maternal age, race/ethnicity, body mass index, smoking, education, payer, parity, and prenatal care. Main outcome measures Preterm birth (PTB) was assessed overall (20–36 weeks of gestation) and by subphenotype: preterm prelabour rupture of membranes (PPROM), spontaneous birth, or medically indicated PTB. The risk of PTB overall and for each phenotype was partitioned by gestational age: early (20–31 weeks of gestation) and late (32–36 weeks of gestation). Results Risks for PTB were elevated for each autoimmune disease evaluated: SLE (RR 3.27, 95% CI 3.01–3.56), RA (RR 2.04, 95% CI 1.79–2.33), SSc (RR 3.74, 95% CI 2.51–5.58), JIA (RR 2.23, 95% CI 1.54–3.23), and DM/PM (RR 5.26, 95% CI 3.12–8.89). These elevated risks were observed for the majority of PTB phenotypes as well. Conclusions Women with systemic autoimmune diseases appear to have an elevated risk of various PTB phenotypes. Therefore, preconception counselling and close monitoring during pregnancy is crucial. Tweetable This study found that women with systemic autoimmune diseases have an elevated risk of preterm birth phenotypes. Tweetable This study found that women with systemic autoimmune diseases have an elevated risk of preterm birth phenotypes.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Contribution to Authorship KDK, JAM, LC, YC, VMK, MD, DKS, GMS, JFS study design; JAM data analysis; KDK, JAM, LC, YC, VMK, MD, DKS, GMS, JFS drafting the manuscript and critical revisions. All authors have seen and approved the final version of the manuscript.
ISSN:	1470-0328 1471-0528
DOI:	10.1111/1471-0528.15970