Autoimmune diseases and adverse pregnancy outcomes: an umbrella review

• Published in: BMC medicine Vol. 22; no. 1; pp. 94 - 19
• Main Authors: Singh, Megha, Wambua, Steven, Lee, Siang Ing, Okoth, Kelvin, Wang, Zhaonan, Fayaz, Fathima Fazla Ahamed, Eastwood, Kelly-Ann, Nelson-Piercy, Catherine, Reynolds, John A, Nirantharakumar, Krishnarajah, Crowe, Francesca
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.03.2024; BioMed Central; BMC
• Subjects: Autoimmune diseases; Autoimmune Diseases - complications; Autoimmune Diseases - epidemiology; Birth weight; Care and treatment; Celiac Disease; Chronic conditions; Citation management software; Complications and side effects; Crohn Disease; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1; Diagnosis; Disease; Female; Females; Gastrointestinal diseases; Gestational age; Health risks; Humans; Infant; Infant, Newborn; Inflammatory bowel disease; Inflammatory Bowel Diseases; Low birth weight; Lupus; Lupus Erythematosus, Systemic; Medical research; Multiple sclerosis; Postnatal care; Pre-eclampsia; Pregnancy; Pregnancy complications; Pregnancy, Complications of; Pregnant women; Premature birth; Premature Birth - epidemiology; Psoriasis; Reviews; Rheumatoid arthritis; Risk; Risk assessment; Risk factors; Scleroderma; Scleroderma (Disease); Scleroderma, Systemic - epidemiology; Sjogren's syndrome; Small for gestational age; Systematic review; Systemic lupus erythematosus; Systemic scleroderma; Systemic sclerosis; Type 1 diabetes; Womens health; United Kingdom; Pregnancy; Autoimmune diseases; Pregnancy complications
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-024-03309-y

There is a high prevalence of autoimmune conditions in women specially in the reproductive years; thus, the association with adverse pregnancy outcomes has been widely studied. However, few autoimmune conditions/adverse outcomes have been studied more than others, and this umbrella review aims to consolidate existing knowledge in this area with the aim to provide new knowledge and also identify gaps in this research area. Medline, Embase, and Cochrane databases were searched from inception to December 2023. Screening, data extraction, and quality appraisal (AMSTAR 2) were done by two independent reviewers. Data were synthesised narratively and quantitatively. Relative risks (RR)/odds ratio (OR) with 95% confidence intervals were reported. Thirty-two reviews were included consisting of 709 primary studies. The review reported the association between 12 autoimmune conditions and 16 adverse pregnancy outcomes. Higher risk of miscarriage is reported in women with Sjögren's syndrome RR 8.85 (95% CI 3.10-25.26) and systemic lupus erythematosus (SLE) OR 4.90 (3.10-7.69). Pre-eclampsia was reported higher in women with type 1 diabetes mellitus (T1DM) OR 4.19 (3.08-5.71) and SLE OR 3.20 (2.54-4.20). Women reported higher risk of diabetes during pregnancy with inflammatory bowel disease (IBD) OR 2.96 (1.47-5.98). There was an increased risk of intrauterine growth restriction in women with systemic sclerosis OR 3.20 (2.21-4.53) and coeliac disease OR 1.71 (1.36-2.14). Preterm birth was associated with T1DM OR 4.36 (3.72-5.12) and SLE OR 2.79 (2.07-3.77). Low birth weight babies were reported in women with women with SLE or systemic sclerosis OR 5.95 (4.54-7.80) and OR 3.80 (2.16-6.56), respectively. There was a higher risk of stillbirth in women with T1DM OR 3.97 (3.44-4.58), IBD OR 1.57 (1.03-2.38), and coeliac disease OR 1.57 (1.17-2.10). T1DM in women was associated with 32% lower odds of small for gestational age baby OR 0.68 (0.56-0.83). Pregnant women with autoimmune conditions are at a greater risk of developing adverse pregnancy outcomes. Further research is required to develop better preconception to postnatal care for women with autoimmune conditions.