Journal article
Mediation of Adverse Pregnancy Outcomes in Autoimmune Conditions by Pregnancy Complications: A Mediation Analysis of Autoimmune Conditions and Adverse Pregnancy Outcomes
Arthritis care & research (2010), Vol.72(2), pp.256-264
02/2020
DOI: 10.1002/acr.24037
PMCID: PMC7351244
PMID: 31373768
Abstract
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 <10% of excess adverse pregnancy outcomes. Of the 4 autoimmune conditions, selected pregnancy complications mediated the least number of adverse pregnancy outcomes among women with IBD.
Conclusion
We found evidence that some excess risk of adverse pregnancy outcomes is mediated through pregnancy complications, particularly preeclampsia/hypertension. Quantifying excess risk and associated pathways provides insight into the underlying etiologies of adverse pregnancy outcomes and can inform intervention strategies.
Details
- Title: Subtitle
- Mediation of Adverse Pregnancy Outcomes in Autoimmune Conditions by Pregnancy Complications: A Mediation Analysis of Autoimmune Conditions and Adverse Pregnancy Outcomes
- Creators
- Gretchen Bandoli - University of CaliforniaNamrata Singh - University of Iowa Hospitals and Clinics and Iowa City Veteran's Administration Medical CenterJennifer Strouse - University of Iowa Carver College of MedicineRebecca J Baer - California Preterm Birth Initiative at University of CaliforniaBrittney M Donovan - Vanderbilt University Medical CenterSky K Feuer - California Preterm Birth Initiative at University of CaliforniaNichole Nidey - University of IowaKelli K Ryckman - University of IowaLaura L Jelliffe‐Pawlowski - California Preterm Birth Initiative at University of CaliforniaChristina D Chambers - University of California
- Resource Type
- Journal article
- Publication Details
- Arthritis care & research (2010), Vol.72(2), pp.256-264
- DOI
- 10.1002/acr.24037
- PMID
- 31373768
- PMCID
- PMC7351244
- NLM abbreviation
- Arthritis Care Res (Hoboken)
- ISSN
- 2151-464X
- eISSN
- 2151-4658
- Number of pages
- 9
- Grant note
- California Preterm Birth Initiative
- Language
- English
- Date published
- 02/2020
- Academic Unit
- Stead Family Department of Pediatrics; Epidemiology; Addiction Medicine; Craniofacial Anomalies Research Center; Internal Medicine
- Record Identifier
- 9984214818502771
Metrics
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