Objective To examine the relationship between maternal characteristics, serum biomarkers, and preterm birth (PTB) by spontaneous and medically-indicated subtypes. Design Population-based cohort. Setting California, United States of America. Population From a total population of 1,004,039 live singleton births in 2009 and 2010, 841,665 pregnancies with linked birth certificate and hospital discharge records were included. Methods Characteristics were compared for term and preterm deliveries by PTB subtype using logistic regression and odds ratios adjusted for maternal characteristics and obstetric factors present in final stepwise models (adjORs) and 95% confidence intervals (CIs). First and second trimester serum marker levels were analyzed in a subset of 125,202 pregnancies with available first and second trimester serum biomarker results. Main Outcome Measure PTB by subtype. Results In fully adjusted models, ten characteristics and three serum biomarkers were associated with increased risk in each PTB subtype (Black race/ethnicity, preexisting hypertension with and without preeclampsia, gestational hypertension with preeclampsia, preexisting diabetes, anemia, previous PTB, one or ≥ two previous cesarean section(s), interpregnancy interval ≥ 60 months, low first trimester pregnancy-associated plasma protein A, high second trimester alpha-fetoprotein, and high second trimester dimeric inhibin A). These risks occurred in 51.6 to 86.2% of all pregnancies ending in PTB depending on subtype. The highest risk observed was for medically-indicated PTB < 32 weeks in women with preexisting hypertension and preeclampsia (adjOR 89.7, 27.3 – 111.2). Conclusions Our findings suggest a shared etiology across PTB subtypes. These commonalities point to targets for further study and exploration of risk reduction strategies.

BackgroundAutoimmune rheumatic diseases (ARDs) often affect women of childbearing age and have been associated with adverse pregnancy outcomes. Most of the literature on the impact of ARDs on birth outcomes to date has focused on the burden of common ARDs (e.g., rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)) within Caucasian populations. The effect of race/ethnicity on birth outcomes among women with ARDs is not well understood. Identification of groups who are at highest risk of adverse birth outcomes may aid in increased prenatal surveillance and prevention of maternal and fetal morbidity.ObjectivesTo evaluate the impact of ARD on adverse birth outcomes, specifically preterm birth (PTB), congenital anomalies, and low birth weight (LBW), in a large, ethnically diverse cohort.MethodsWe conducted a matched cohort analysis of retrospective data from all singleton live births in California occurring between 2007 and 2012. Data on ARD diagnosis, including RA, SLE, antiphospholipid syndrome (APS), psoriatic arthritis (PsA), ankylosing spondylitis (AS), or juvenile idiopathic arthritis (JIA), and birth outcomes were derived from birth certificate records linked to hospital/discharge ICD9 codes present anytime at or one year prior to delivery. Women without any of the previously mentioned rheumatic diseases were age- and ethnicity-matched in 2:1 ratio to women with ARD; their characteristics were compared using conditional logistic regression. We also examined the association between specific ARD diagnoses and birth outcomes stratified by race/ethnicity.ResultsWe identified 10 975 women with a recorded ARD diagnosis (RA: 3129 (26%), SLE: 3863 (33%), APS: 4180 (35%), PsA: 173 (2%), AS: 144 (1%), and JIA: 354 (3%)). The odds of PTB were increased for women with any ARD (aOR 1.90 (95% CI 1.76–2.05)) and among those with RA (aOR 1.65 (95% CI 1.47–1.85)), SLE (aOR 2.25 (95% CI 2.05–2.47)), APS (aOR 1.82 (95% CI 1.64–2.01)), and JIA (aOR 1.76 (95% CI 1.32–2.35)) compared to women without ARD. After stratifying by race/ethnicity, the odds of PTB and congenital anomalies were highest among Asian women and the odds of LBW were highest among Hispanic women compared to other race/ethnicity-matched controls (table 1). Further sub-analyses revealed that it was predominantly women with SLE who were contributing to the adverse outcomes seen in the combined ARD group.Abstract THU0675 – Table 1Odd of adverse birth outcomes among women with autoimmune rheumatic disease (ARD) compared with women without a recorded ARD by race/ethnicity.ConclusionsConsistent with prior literature, we found that women with ARDs tend to be more likely to have PTB and infants of LBW. To our knowledge, this is the largest study to date to analyse these associations in Asian women. Our results suggest that Asian and Hispanic women with ARDs may disproportionally benefit from additional monitoring throughout pregnancy. Our study raises the need for public health initiatives that can help improve pregnancy outcomes in women with autoimmune rheum...

No abstract