Women with autoimmune conditions, in particular systemic lupus erythematosus, systemic sclerosis and Sjögren’s syndrome, are at significantly higher risk of experiencing adverse pregnancy outcomes, a large-scale review has confirmed.
It also highlighted an urgent need for more research on the potential pregnancy risks across a wider range of autoimmune disorders, as well as the development of new guidelines to help inform clinicians and patients in making personalised treatment decisions.
The umbrella review, undertaken by researchers from the Institute of Applied Health Research, University of Birmingham and published in BMC Medicine, was based on 709 primary studies investigating links between autoimmune conditions and adverse pregnancy outcomes.
Overall, the review found that an association was reported between 12 autoimmune conditions and 16 adverse pregnancy outcomes.
Women with systemic lupus erythematosus (SLE) had a greater risk of miscarriage (OR 4.90), pre-eclampsia (OR 3.20), having a baby small for gestational age (OR 2.49), a preterm birth (OR 2.79) and having a baby with a low birth weight (OR 5.95).
There was also a very high risk of stillbirth in women with SLE, although confidence intervals were particularly wide (OR 16.90; CI 3.02-94.40), researchers noted.
Women with systemic sclerosis had higher risk of miscarriage (OR 1.60), intrauterine growth restriction (OR 3.20), pre-eclampsia (OR 2.20), pre-term birth (OR 2.40) and having a baby with low birth weight (OR 5.95).
Sjögren’s syndrome was linked with a significantly higher risk of miscarriage (RR 8.85), low birth weight (OR 3.80) and an increased risk of intrauterine growth restriction (OR 3.20).
According to the data, women with rheumatoid arthritis are at significantly higher risk of miscarriage (OR 1.32), low birth weight (OR 1.73), having a baby of small gestational age (OR 1.48) and stillbirth (OR 1.99).
Psoriasis and psoriatic arthritis were linked with a 20-50% higher odds of gestational hypertension (OR 1.29 and OR 1.49, respectively), and raised risk of preterm birth (OR 1.22 and OR 1.48), but only psoriasis increased the likelihood of miscarriage (OR 1.10).
The findings are in line with previous literature showing a higher risk of a number of adverse pregnancy outcomes in women with certain autoimmune diseases, particularly SLE and systemic sclerosis, the researchers noted.
“Given the potential adverse outcomes, more clinical guidelines need to be developed to guide the preconception and maternity care for pregnant women with autoimmune conditions,” they added.