Mediation of Adverse Pregnancy Outcomes in Autoimmune Conditions by Pregnancy Complications: A Mediation Analysis of Autoimmune Conditions and Adverse Pregnancy Outcomes
Mediation of Adverse Pregnancy Outcomes in Autoimmune Conditions by Pregnancy Complications: A Mediation Analysis of Autoimmune Conditions and Adverse Pregnancy Outcomes
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DOI：
10.1002/acr.24037
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发表时间：
2020-01-09
影响因子：
4.7
通讯作者：
Chambers, Christina D.
中科院分区：
文献类型：
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作者：
Bandoli, Gretchen;Singh, Namrata;Chambers, Christina D.
目的自身免疫性疾病与不良妊娠并发症和妊娠结局的风险增加相关，提示妊娠并发症可能介导了过度风险。我们进行了因果中介分析，以量化自身免疫性疾病对不良妊娠结局的介导作用。方法：我们查询了一个加州出生队列，该队列是从出生证明和出院总结中创建的。从2，963，888名新生儿中，我们确定了患有类风湿性关节炎（RA），系统性红斑狼疮（SLE），银屑病和炎症性肠病（IBD）的女性。妊娠并发症包括先兆子痫/高血压、妊娠期糖尿病和妊娠期感染。不良妊娠结局为早产、剖宫产和小于胎龄儿。我们进行了中介分析，以估计每种自身免疫性疾病和不良妊娠结局的总影响以及通过妊娠并发症的间接影响。结果4种自身免疫性疾病均与早产和剖宫产相关，RA、SLE和IBD与小于胎龄儿相关。RA、SLE和银屑病的最强介导因素是先兆子痫/高血压，占早产超额风险的20-33%和剖宫产超额风险的10-19%。糖尿病和感染通常由
Objective Autoimmune conditions are associated with an increased risk of adverse pregnancy complications and outcomes, suggesting that pregnancy complications may mediate the excess risk. We performed a causal mediation analysis to quantify the mediated effects of autoimmune conditions on adverse pregnancy outcomes. Methods We queried a California birth cohort created from linked birth certificates and hospital discharge summaries. From 2,963,888 births, we identified women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriasis, and inflammatory bowel disease (IBD). Pregnancy complications included preeclampsia/hypertension, gestational diabetes mellitus, and infection in pregnancy. Adverse pregnancy outcomes were preterm birth, cesarean delivery, and small for gestational age. We performed a mediation analysis to estimate the total effects of each autoimmune condition and adverse pregnancy outcome and the indirect effects through pregnancy complications. Results All 4 autoimmune conditions were associated with preterm birth and cesarean delivery, and RA, SLE, and IBD were associated with offspring that were small for gestational age. The strongest mediator of RA, SLE, and psoriasis was preeclampsia/hypertension, accounting for 20-33% of the excess risk of preterm births and 10-19% of excess cesarean deliveries. Gestational diabetes mellitus and infections generally mediated