Number of parity and the risk of rheumatoid arthritis in women: A dose–response meta‐analysis of observational studies

Ren, Lei; Guo, Ping; Sun, Qiao-Mei; Liu, Hong; Chen, Yu; Huang, Ying; Cai, Xiao-Jun

doi:10.1111/jog.13370

Cited by 17 publications

(15 citation statements)

References 66 publications

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“…As discussed in our introduction, Ren et al have previously systematically reviewed the relationship between parity and the risk of RA in women (19). Our systematic review builds on their earlier work, by evaluating the association between both parity and gravidity and the risk of RA, examining the impact of serology on RA risk, and assessing if risk differs during pregnancy, and the post-partum period.…”

Section: Discussionmentioning

confidence: 99%

“…The "protective effect" of previous pregnancy and childbirth has not, however, been replicated across all studies (16)(17)(18), and its precise impact on RA susceptibility remains uncertain. To date, one systematic literature review and meta-analysis has been undertaken in this area, reporting an inverse relationship between parity and RA risk (19). This review did not, however, evaluate risk by gravidity or childbirth timing, and included results from different analyses undertaken in the same patient groups (including two publications from the Nurses' Health Study, and two from a case-control population in Seattle, USA) (16,(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

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The association between gravidity, parity and the risk of developing rheumatoid arthritis: A systematic review and meta-analysis

Chen

Subesinghe

Müller

et al. 2020

Seminars in Arthritis and Rheumatism

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Objective: to establish if gravidity and parity associate with the development of rheumatoid arthritis (RA), and to establish if this effect is influenced by the time elapsed since pregnancy/childbirth, the number of pregnancies/childbirths, and serological status, through systematically reviewing the literature and undertaking a meta-analysis. Methods: we searched Medline/EMBASE (from 1946-2018) using the terms "rheumatoid arthritis.mp" or "arthritis, rheumatoid/" and "pregnancy.mp" or "pregnancy/" or "parity.mp" or "parity/" or "gravidity.mp" or "gravidity/" (observational study filter applied). Casecontrol/cohort studies that examined the relationship between parity/gravidity and the risk of RA in women were included. Studies reporting effect size data for RA in ever vs. never parous/gravid women as ORs/RRs with 95% confidence intervals were included in a metaanalysis. Other relationships (i.e. risk by pregnancy/childbirth numbers) were analysed descriptively. Results: twenty studies (from 626 articles) met our inclusion criteria, comprising 14 casecontrol (4,799 cases; 11,941 controls) and 6 cohort studies (8,575 cases; 2,368,439 individuals). No significant association was observed in the meta-analysis of studies reporting the risk of RA in ever vs. never parous women (OR 0.91; 95% CI 0.80-1.04) and ever vs. never gravid women (OR 0.86; 95% CI 0.46-1.62). No consistent evidence of a relationship between the number of pregnancies/childbirths and RA risk was seen. No significant association was observed between being pregnant, or in the immediate post-partum period, and the risk of developing RA. Conclusion: our systematic review does not support the concept that gravidity and parity are associated with the risk of RA development.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The association between gravidity, parity and the risk of developing rheumatoid arthritis: A systematic review and meta-analysis

Chen

Subesinghe

Müller

et al. 2020

Seminars in Arthritis and Rheumatism

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“…>7 years) (119–121). Less clear is the relationship between parity and risk for RA, with one study showing no increased risk for seropositive RA based on one or more pregnancies (122), and other studies including a meta-analysis demonstrating a protective effect of pregnancies (123, 124). …”

Section: Environmental Risk Factors For Ramentioning

confidence: 99%

Genetic and environmental risk factors for rheumatoid arthritis

Deane

Demoruelle

Kelmenson

et al. 2017

Best Practice & Research Clinical Rheumatology

471

296

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Multiple genetic and environmental factors have been associated with an increased risk for rheumatoid arthritis (RA). Of these, the strongest associations have been seen with female sex, a family history of RA, the genetic factor the ‘shared epitope’ and with exposure to tobacco smoke. There is also renewed interest in mucosal inflammation and microbial factors as contributors to the development of RA. However, the identification of a ‘preclinical’ period of RA that can be defined as local or systemic autoimmunity as measured by autoantibodies and other biomarkers prior to the development of clinically-apparent synovitis suggests that the risk factors for RA are acting long prior to first clinical evidence of IA. As such, a major challenge to the field will be to investigate the full spectrum of the development of RA, from initiation and propagation of autoimmunity during preclinical RA and transition to clinically-apparent synovitis and classifiable RA, in order to determine which genetic and environmental factors are important at each stage of disease development. Understanding the exact role and timing of action of risk factors for RA is especially important given the advent of prevention trials in RA, and the hope that a full understanding of genetic and environmental factors in RA could lead to effective preventive interventions.

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“…with RA include age at menarche 7,8 , age at menopause [9][10][11][12] , parity [13][14][15][16][17][18] , breast feeding 8,[19][20][21][22] , use of oral contraceptives (OC) [23][24][25][26][27][28] , and hormonal replacement therapy (HRT) 29,30 . For the development of RA, these factors have been described as protective factors 8,14,18,[20][21][22]24,[27][28][29] , risk factors 9,10,12,15,17,23 , or irrelevant 11,25,26,30 , depending on the study, leading to inconsistent results. Previous literature showed that the effect of parity on RA varies with age 15,18 .…”

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confidence: 99%

Menopausal factors and risk of seropositive rheumatoid arthritis in postmenopausal women: a nationwide cohort study of 1.36 million women

Eun

Jeon

Han

et al. 2020

Sci Rep

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In previous literature regarding development of rheumatoid arthritis (RA), female reproductive factors have been described as protective factors, risk factors, or irrelevant, leading to inconsistent results. The aim of this study was to investigate the effect of female reproductive factors on the incidence of seropositive RA. A large population-based retrospective cohort of the National Health Insurance Service data in South Korea was used. Postmenopausal women who participated in both cardiovascular and breast cancer screening in 2009 were included and followed until date of seropositive RA diagnosis, death, or December 31, 2018. Multivariable-adjusted Cox proportional hazards model was used to assess the association between reproductive factors and incident seropositive RA. Of 1,357,736 postmenopausal women, 6056 women were diagnosed with seropositive RA, and the incidence rate was 54.16 cases/100,000 person-years. Reproductive factors other than hormone replacement therapy (HRT) were not significantly associated with seropositive RA incidence. Postmenopausal women who used HRT ≥ 5 years were associated with a higher aHR of incident seropositive RA than never-users (aHR 1.25; 95% CI 1.09–1.44). Alcohol consumption less than 30 g per day (aHR 0.80; 95% CI 0.74–0.87), regular physical activity (aHR 0.90; 95% CI 0.84–0.97), diabetes mellitus (aHR 0.85; 95% CI 0.78–0.93), and cancer (aHR 0.77; 95% CI 0.64–0.92) were associated with lower risk of seropositive RA. Most female reproductive factors did not significantly affect the development of seropositive RA in postmenopausal women. Only HRT is associated with a small but significant increase in risk of seropositive RA.

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Number of parity and the risk of rheumatoid arthritis in women: A dose–response meta‐analysis of observational studies

Cited by 17 publications

References 66 publications

The association between gravidity, parity and the risk of developing rheumatoid arthritis: A systematic review and meta-analysis

The association between gravidity, parity and the risk of developing rheumatoid arthritis: A systematic review and meta-analysis

Genetic and environmental risk factors for rheumatoid arthritis

Menopausal factors and risk of seropositive rheumatoid arthritis in postmenopausal women: a nationwide cohort study of 1.36 million women

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