Risk of preterm delivery and small-for-gestational-age births in women with autoimmune disease using biologics before or during pregnancy: a population-based cohort study

Tsao, Nicole W.; Sayre, Eric C.; Hanley, Gillian E.; Sadatsafavi, Mohsen; Lynd, Larry D.; Marra, Carlo A.; Vera, Mary A. De

doi:10.1136/annrheumdis-2018-213023

Cited by 21 publications

(25 citation statements)

References 25 publications

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“…Several studies have not found increased risks of adverse birth outcomes . Luu et al recently reported an increased risk for complications as a composite criterion, not specifying risk estimates for particular birth outcomes .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have not found increased risks of adverse birth outcomes. 31,32 Luu et al recently reported an increased risk for complications as a composite criterion, not specifying risk estimates for particular birth outcomes. 11 In other studies, risk estimates were slightly increased, or the prevalence of adverse birth outcomes differed between exposed and unexposed patients, but formal analyses were limited by few events.…”

Section: Strengths and Limitations In Relation To Other Studiesmentioning

confidence: 99%

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Anti‐TNF treatment during pregnancy and birth outcomes: A population‐based study from Denmark, Finland, and Sweden

Bröms

Kieler

Ekbom

et al. 2020

Pharmacoepidemiology and Drug

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Purpose To study the risk of preterm birth, caesarean section, and small for gestational age after anti‐tumor necrosis factor agent treatment (anti‐TNF) in pregnancy. Methods Population‐based study including women with inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis, and their infants born 2006 to 2013 from the national health registers in Denmark, Finland, and Sweden. Women treated with anti‐TNF were compared with women with nonbiologic systemic treatment. Adalimumab, etanercept, and infliximab were compared pairwise. Continuation of treatment in early pregnancy was compared with discontinuation. Odds ratios with 95% confidence intervals were calculated in logistic regression models adjusted for country and maternal characteristics. Results Among 1 633 909 births, 1027 infants were to women treated with anti‐TNF and 9399 to women with nonbiologic systemic treatment. Compared with non‐biologic systemic treatment, women with anti‐TNF treatment had a higher risk of preterm birth, odds ratio 1.61 (1.29‐2.02) and caesarean section, 1.57 (1.35‐1.82). The odds ratio for small for gestational age was 1.36 (0.96‐1.92). In pairwise comparisons, infliximab was associated with a higher risk of severely small for gestational age for inflammatory joint and skin diseases but not for inflammatory bowel disease. Discontinuation of anti‐TNF had opposite effects on preterm birth for inflammatory bowel disease and inflammatory joint and skin diseases. Conclusions Anti‐TNF agents were associated with increased risks of preterm birth, caesarean section, and small for gestational age. However, the diverse findings across disease groups may indicate an association related to the underlying disease activity, rather than to agent‐specific effects.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitations In Relation To Other Studiesmentioning

confidence: 99%

Anti‐TNF treatment during pregnancy and birth outcomes: A population‐based study from Denmark, Finland, and Sweden

Bröms

Kieler

Ekbom

et al. 2020

Pharmacoepidemiology and Drug

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“…Prolong inflammation can lead to placenta insufficiency and resulted in intrauterine growth restriction, miscarriage, preterm birth, pre-eclampsia and small for gestational age (SGA) [8,10,11]. Additionally, the use of disease-modifying anti-rheumatic drugs and biologics for disease control also raised the concern for pregnancy interruption [9,12]. Clear understanding of the potential adverse events not only provide patients with better preconceptional and prenatal counselling, but likely ease JIA mothers from inexplicable worries.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes and perinatal complications of Asian mothers with juvenile idiopathic arthritis – a case-control registry study

et al. 2020

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Backgrounds: In order to provide juvenile idiopathic arthritis (JIA) patients with better pre-conceptional and prenatal counselling, we investigated the obstetrical and neonatal outcomes among women with Asian descent. Methods: Through the linkage of Taiwan National Health Insurance database and National Birth Registry, we established a population-based birth cohort in Taiwan between 2004 and 2014. In a case control study design, first children born to mothers with JIA are identified and matched with 5 non-JIA controls by maternal age and birth year. Conditional logistic regression was used to calculate odds ratios for maternal and neonatal outcomes crude and with adjustment. Results: Of the 2,100,143 newborn, 778 (0.037%) were born to JIA mothers. Among them, 549 first-born children were included in this research. Our result suggested that babies born to mothers with JIA were more likely to have low birth body weight, with an adjusted OR of 1.35(95% CI: 1.02 to 1.79) when compared to babies born to mothers without. No differences were observed in other perinatal complications between women with and without JIA including stillbirth, prematurity, or small for gestational age. The rate of adverse obstetrical outcomes such as caesarean delivery, preeclampsia, gestational diabetes, postpartum hemorrhage and mortality were also similar between the two. Conclusions: Adverse obstetrical and neonatal outcomes were limited among Asian mothers with JIA. Intensive care may not be necessary for JIA mothers and their newborns.

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“…There are more than 70 diseases classified as autoimmune diseases at present, and their prevalence in the general population is about 7% (Cooper et al, 2009). Many autoimmune diseases have a significantly higher incidence in women than men, including SLE and RA, which may be caused by female sex hormones regulating the immune system through sex hormone receptors (Adams Waldorf and Nelson, 2008;Cai et al, 2019;Tsao et al, 2019). During pregnancy, the mother undergoes a series of physiological changes to ensure the healthy growth of the fetus, including immune, hormonal, and metabolic changes (Kumar and Magon, 2012).…”

Section: Autoimmune Diseasesmentioning

confidence: 99%

The Role of Microbiomes in Pregnant Women and Offspring: Research Progress of Recent Years

et al. 2020

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Pregnancy is a complicated and delicate process, the maternal body undergoes changes on hormones, immunity, and metabolism during pregnancy to support fetal development. Microbiomes in the human body mainly live in the intestine, and the human gut microbiomes are complex, which composed of more than 500 to 1500 different bacteria, archaea, fungi, and viruses. Studies have shown that these microbiomes are not only involved in the digestion and absorption of food but also indispensable in regulating host health. In recent years, there has been increasing evidence that microbiomes are important for pregnant women and fetuses. During pregnancy, there will be great changes in gut microbiomes. Regulating gut microbiomes is beneficial to the health of the mother and the fetus. In addition, many complications during pregnancy are related to gut microbiomes, such as gestational diabetes, obesity, preeclampsia, digestive disorders, and autoimmune diseases. Moreover, the microbiomes in mother's milk and vagina are closely related to the colonization of microbiomes in the early life of infants. In this review, we systematically review the role of maternal microbiomes in different gestational complications, and elucidate the function and mechanism of maternal microbiomes in the neural development and immune system of offspring. These will provide a clear knowledge framework or potential research direction for researchers in related fields.

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Risk of preterm delivery and small-for-gestational-age births in women with autoimmune disease using biologics before or during pregnancy: a population-based cohort study

Abstract: These population-based data suggest that the use of biologics before and during pregnancy is not associated with an increased risk of preterm delivery or SGA births.

Cited by 21 publications

References 25 publications

Anti‐TNF treatment during pregnancy and birth outcomes: A population‐based study from Denmark, Finland, and Sweden

Anti‐TNF treatment during pregnancy and birth outcomes: A population‐based study from Denmark, Finland, and Sweden

Pregnancy outcomes and perinatal complications of Asian mothers with juvenile idiopathic arthritis – a case-control registry study

The Role of Microbiomes in Pregnant Women and Offspring: Research Progress of Recent Years

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