Rheumatic diseases linked to childbearing problems, finds study

Immune-mediated diseases encompass a diverse range of conditions, all characterized by abnormal immune system activity. While some, like type 1 diabetes, typically manifest before reproductive age, others emerge later in life. Scientists have investigated systemic lupus erythematosus for its effects on reproductive health as the condition increases the risk for some adverse pregnancy outcomes, including pre-eclampsia, preterm delivery, C-sections, and low birth weight. However, the impact of other autoimmune diseases—such as psoriasis—on fertility and pregnancy is unclear.

In the study, researchers used data from Finnish nationwide health registers to study the impact of immune-mediated diseases on reproductive health measures such as reproductive success, and for women, ever having experienced adverse maternal and perinatal outcomes. Out of all people born in Finland between 1964 and 1984, 7.9% of the women and 7.8% of the men had an autoimmune disease diagnosed before or during reproductive years.

The findings highlighted that many immune-mediated diseases had little impact on the number of children. However, women with selected immune-mediated diseases experience a higher prevalence of childlessness, with the top three diseases being Addison’s disease (23.9% more childlessness), juvenile idiopathic arthritis (9.3%), and vitamin B12 deficiency anaemia (8.6%). Several of the rheumatic diseases—particularly systemic lupus erythematosus and juvenile idiopathic arthritis—lead to higher rates of childlessness and fewer children.

The risks for pre-eclampsia, low birth weight, preterm delivery, non-elective C-sections and need of neonatal intensive care were increased for many conditions. Systemic lupus erythematosus and type 1 diabetes showed over two-fold risks for some of these outcomes. However, the risk of gestational diabetes was not higher for patients with any of the rheumatic diseases compared to the population.

“Despite seeing an elevated risk for diverse childbearing problems in rheumatic and other immune-mediated diseases, many of the complications are still fairly rare,” said Anne Kerola, the lead author of the study. “Family planning should actively be discussed between patients, both men and women, with rheumatic diseases and their healthcare providers. Pregnancies in women with rheumatic diseases are carefully followed up to tailor medications appropriately, which helps reduce risks.”

Reference: Anne M Kerola, Antti Palomäki, Hannele Laivuori, Tarja Laitinen, Martti Färkkilä, Kari K Eklund, Samuli Ripatti, Markus Perola, Andrea Ganna, Joni V Lindbohm, Nina Mars; Patterns of reproductive health in inflammatory rheumatic diseases and other immune-mediated diseases: a nationwide registry study; Journal: Rheumatology; DOI: 10.1093/rheumatology/keae122