National cohort study of reproductive risk factors for rheumatoid arthritis in Denmark: a role for hyperemesis, gestational hypertension and pre-eclampsia?

Jørgensen, Kristian Tore; Pedersen, Bo Vest; Jacobsen, Søren; Biggar, Robert J.; Frisch, Mørten

doi:10.1136/ard.2008.099945

Cited by 55 publications

(55 citation statements)

References 44 publications

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“…Hormonal and immunological imbalances have been suggested to be involved in all these different abnormal pregnancy outcomes [16e20]; conditions that might also contribute to the development of ADs. We have previously shown that spontaneous abortions, missed abortions and stillbirths are associated with increased risk of SLE and that hyperemesis, gestational hypertension and preeclampsia are associated with increased risk of rheumatoid arthritis [21,22]. In contrast, we observed no association between pregnancy complications or losses and subsequent risk of multiple sclerosis [23].…”

Section: Introductioncontrasting

confidence: 78%

Hyperemesis, gestational hypertensive disorders, pregnancy losses and risk of autoimmune diseases in a Danish population-based cohort

Jørgensen

Nielsen

Pedersen

et al. 2012

Journal of Autoimmunity

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Section: Introductioncontrasting

confidence: 78%

Hyperemesis, gestational hypertensive disorders, pregnancy losses and risk of autoimmune diseases in a Danish population-based cohort

Jørgensen

Nielsen

Pedersen

et al. 2012

Journal of Autoimmunity

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“…A recent publication showed a skewed placental weight‐to‐birth weight ratio, possibly reflecting suboptimal placentation, but this was found only in women with HG who were carrying female fetuses 35. Moreover, HG is reported to be associated with subsequent increased risk of autoimmune diseases 23, 24. A Danish study found a statistically significant association between HG and autoimmune diseases in general and in particular between HG and Sjögren's syndrome, Graves’ disease, rheumatoid arthritis, pernicious anaemia, coeliac disease, Crohn's disease, ulcerative colitis and psoriasis 23.…”

Section: Discussionmentioning

confidence: 99%

“…Although HG is the most common reason for hospitalisation during the first trimester,22 little is known about the long‐term consequences of HG exposure. Some studies have reported an association between HG and risk of autoimmune disease later in life 23, 24. A recent study investigating cancer risk after HG exposure reported an inverse association between HG and overall cancer risk 25.…”

Section: Introductionmentioning

confidence: 99%

Hyperemesis gravidarum and long‐term mortality: a population‐based cohort study

Fossum

Vikanes

Næss

et al. 2016

BJOG

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ObjectiveTo investigate whether exposure to hyperemesis gravidarum (HG) is associated with increased maternal long‐term mortality.DesignPopulation‐based cohort study.SettingMedical Birth Registry of Norway (1967–2002) linked to the Cause of Death Registry.PopulationWomen in Norway with singleton births in the period 1967–2002, with and without HG. Women were followed until 2009 or death.MethodsCox proportional hazard regression model was applied to estimate hazard ratios (HRs) with 95% confidence interval (CI).Main outcome measuresThe primary outcome was all‐cause mortality during follow up. Secondary outcomes were cause‐specific mortality (cardiovascular mortality, deaths due to cancer, external causes or mental and behavioural disorders).ResultsOf 999 161 women with singleton births, 13 397 (1.3%) experienced HG. During a median follow up of 26 years (25 902 036 person‐years), 43 470 women died (4.4%). Women exposed to HG had a lower risk of long‐term all‐cause mortality compared with women without HG (crude HR 0.82; 95% CI 0.75–0.90). When adjusting for confounders, this reduction was no longer significant (adjusted HR 0.92; 95% CI 0.84–1.01). Women exposed to HG had a similar risk of cardiovascular death as women not exposed (adjusted HR 1.04; 95% CI 0.83–1.29), but a lower long‐term risk of death from cancer (adjusted HR 0.86; 95% CI 0.75–0.98).ConclusionIn this large population‐based cohort study, HG was not associated with an increased risk of long‐term all‐cause mortality. Women exposed to HG had no increase in mortality due to cardiovascular disease, but had a reduced risk of death from cancer.Tweetable abstractPopulation‐based cohort study: Hyperemesis was not associated with an increased risk of long‐term mortality.

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“…While results of published studies on the association between pregnancy and SLE are contradictory [5,6], evidence suggests that the risk of multiple sclerosis onset is reduced during gestation and increased in the first 6 months after pregnancy [7,8]. It is unclear, despite much investigation, whether there is an association between parity and the risk of rheumatoid arthritis [9][10][11]. The currently available data do not provide convincing evidence that parity provides an explanation for the female predominance in the majority of autoimmune conditions.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy and the risk of autoimmune disease

O’Donoghue

2011

Chimerism

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Autoimmune diseases (AID) predominantly affect women of reproductive age. While basic molecular studies have implicated persisting fetal cells in the mother in some AID, supportive epidemiological evidence is limited. We investigated the effect of vaginal delivery, caesarean section (CS) and induced abortion on the risk of subsequent maternal AID. Using the Danish Civil Registration System (CRS) we identified women who were born between 1960 and1992. We performed data linkage between the CRS other Danish national registers to identify women who had a pregnancy and those who developed AID. Women were categorised into 4 groups; nulligravida (control group), women who had 1st child by vaginal delivery, whose 1st delivery was by CS and who had abortions. Log-linear Poisson regression with person-years was used for data analysis adjusting for several potential confounders. There were 1,035,639 women aged .14 years and 25,570 developed AID: 43.4% nulligravida, 44.3% had their first pregnancy delivered vaginally, 7.6% CS and 4.1% abortions. The risk of AID was significantly higher in the 1st year after vaginal delivery (RR = 1.1[1.0, 1.2]) and CS (RR = 1.3[1.1, 1.5]) but significantly lower in the 1st year following abortion (RR = 0.7[0.6, 0.9]). These results suggest an association between pregnancy and the risk of subsequent maternal AID. Increased risks of AID after CS may be explained by amplified fetal cell traffic at delivery, while decreased risks after abortion may be due to the transfer of more primitive fetal stem cells. The increased risk of AID in the first year after delivery may also be related to greater testing during pregnancy.

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National cohort study of reproductive risk factors for rheumatoid arthritis in Denmark: a role for hyperemesis, gestational hypertension and pre-eclampsia?

Cited by 55 publications

References 44 publications

Hyperemesis, gestational hypertensive disorders, pregnancy losses and risk of autoimmune diseases in a Danish population-based cohort

Hyperemesis, gestational hypertensive disorders, pregnancy losses and risk of autoimmune diseases in a Danish population-based cohort

Hyperemesis gravidarum and long‐term mortality: a population‐based cohort study

Pregnancy and the risk of autoimmune disease

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