Fecundity before disease onset in women with rheumatoid arthritis

Nelson, J. Lee; Koepsell, Thomas D.; Dugowson, Carin E.; Voigt, Lynda F.; Daling, Janet R.; Hansen, John A.

doi:10.1002/art.1780360103

Cited by 89 publications

(43 citation statements)

References 14 publications

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“…In addition, women diagnosed with RA before age 18 years or before bearing children were found to have fewer total children than women diagnosed later in their lives (3,4,11). Other studies detected no differences in conception rates, but these were early investigations that did not distinguish between a woman's intention to conceive and her ability to conceive (12,13).…”

Section: Discussionmentioning

confidence: 99%

Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus

Clowse

Chakravarty

Costenbader

et al. 2012

Arthritis Care & Research

156

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Objective. Women with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have fewer children on average than other women. We sought to determine the roles of infertility, pregnancy loss, and personal choice on family size in women with these diseases. Methods. A reproductive history questionnaire was completed by women with RA and SLE participating in a longitudinal observational study. Within each disease cohort, participants were divided into 3 groups: those interested in having children at symptom onset who had either fewer children than planned (group A) or the same number as planned (group B), and those no longer interested in having children at diagnosis (group C). Results. Of the 578 RA and 114 SLE women surveyed, >60% were in group C. Of those interested in having children, 55% with RA and 64% with SLE had fewer children than originally planned. Among women with RA, group A had 1 less pregnancy, 1 less live birth, and an infertility rate 1.5 times higher than group B; the miscarriage rate was similar in both groups. Compared to SLE group B, SLE group A had a similar number of pregnancies, but a 3-fold higher rate of miscarriage and 1 less live birth. Concerns about child health and personal welfare were associated with a lower pregnancy rate. Conclusion. In this population, more than one-half of young women with RA or SLE had fewer biologic children than desired. While patient choice plays a role, infertility in RA patients and miscarriage in SLE patients are also important.

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Section: Discussionmentioning

confidence: 99%

Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus

Clowse

Chakravarty

Costenbader

et al. 2012

Arthritis Care & Research

156

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“…RA probably does not affect fertility, although a decrease in fecundity prior to disease onset (time interval to conception) has been described. (Nelson et al 1993a) There is no evidence that RA increases risk of spontaneous abortions, preterm labor or preeclampsia. (Branch and Porter 1999;Nelson and Ostensen 1997) Plasma cortisol, which rises during pregnancy to peak at term, was initially thought to be important in the pregnancy-induced amelioration of RA.…”

Section: A Rheumatoid Arthritis and The Changing Maternal "Self" Hypmentioning

confidence: 99%

Autoimmune Disease During Pregnancy and the Microchimerism Legacy of Pregnancy

Waldorf

Nelson

2008

Immunological Investigations

159

137

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Pregnancy has both short-term effects and long-term consequences. For women who have an autoimmune disease and subsequently become pregnant, pregnancy can induce amelioration of the mother's disease, such as in rheumatoid arthritis, while exacerbating or having no effect on other autoimmune diseases like systemic lupus erythematosus. That pregnancy also leaves a long-term legacy has recently become apparent by the discovery that bi-directional cell trafficking results in persistence of fetal cells in the mother and of maternal cells in her offspring for decades after birth. The long-term persistence of a small number of cells (or DNA) from a genetically disparate individual is referred to as microchimerism. While microchimerism is common in healthy individuals and is likely to have health benefits, microchimerism has been implicated in some autoimmune diseases such as systemic sclerosis. In this paper, we will first discuss short-term effects of pregnancy on women with autoimmune disease. Pregnancy-associated changes will be reviewed for selected autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus and autoimmune thyroid disease. The pregnancy-induced amelioration of rheumatoid arthritis presents a window of opportunity for insights into both immunological mechanisms of fetal-maternal tolerance and pathogenic mechanisms in autoimmunity. A mechanistic hypothesis for the pregnancy-induced amelioration of rheumatoid arthritis will be described. We will then discuss the legacy of maternal-fetal cell transfer from the perspective of autoimmune diseases. Fetal and maternal microchimerism will be reviewed with a focus on systemic sclerosis (scleroderma), autoimmune thyroid disease, neonatal lupus and type I diabetes mellitus.Keywords autoimmune disease; pregnancy; microchimerism; systemic lupus erythematosus; rheumatoid arthritis PREGNANCY IN WOMEN WITH PRE-EXISTING AUTOIMMUNE DISEASEAutoimmune disease may complicate pregnancy in many different ways adding to the immunologic challenges already faced by the mother. The maternal immune system must avoid rejecting a semi-allogeneic fetus, remain immunocompetent to fight infections, and clear abnormal cells (e.g. precancerous) that could be harmful to the mother or fetus. Symptoms of an autoimmune disease could improve, worsen, or remain unchanged when a et al. 1987) In contrast, only a weak association between SLE susceptibility and HLA-DRB1*15 or DRB1*03 has been found in specific ethnic groups; it has been suggested that these associations are instead related to genes in linkage disequilibrium (e.g. gene encoding tumor necrosis factor-alpha with HLA-DRB1*15). (Jacob et al. 1990;Vyse and Kotzin 1998) Sex hormones and the immunologic effects of pregnancy have been investigated in autoimmunity. The well-studied relationship between sex hormones and lupus-like disease in animal models suggests a contributory role for estrogen in disease exacerbation and possibly in disease susceptibility. SLE may occur more frequently in women who have ...

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“…Two other studies have suggested that fertility or fecundity may be decreased among women with RA (116,117), whereas others have found that fertility or fecundity do not differ from healthy controls (112). Although fertility is normal in SLE, increased fetal loss either as miscarriage or stillbirth has been reported (118 -122).…”

Section: Systemic Diseases and Ovarian Dysfunctionmentioning

confidence: 99%

Gonadal dysfunction in systemic diseases

2005

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Gonadal function is significantly affected in many acute and chronic systemic diseases. As the function of the testes and the ovaries is determined by the integrity of the hypothalamic -pituitary-gonadal axis, it is obvious that a systemic disease may affect one or more levels of the axis in such a manner that the gonadal dysfunction may have various clinical and laboratory manifestations. In this brief review, the most common disturbances seen in the main systemic diseases will be discussed.

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Fecundity before disease onset in women with rheumatoid arthritis

Cited by 89 publications

References 14 publications

Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus

Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus

Autoimmune Disease During Pregnancy and the Microchimerism Legacy of Pregnancy

Gonadal dysfunction in systemic diseases

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