Bidirectional association of autoimmune diseases and pregnancy complications

Singh, Megha ORCID: 0000-0003-3680-7124 (2025). Bidirectional association of autoimmune diseases and pregnancy complications. University of Birmingham. Ph.D.

Singh2025PhD.pdf
Text - Accepted Version
Available under License All rights reserved.
Download (17MB)

Abstract

Background- Given the global rise of autoimmune conditions, particularly in women of reproductive age, there is a need to better understand their burden during pregnancy and their impact on pregnancy outcomes. Despite extensive research, certain autoimmune conditions and pregnancy complications have been more thoroughly examined than others. Also, how the pregnancy complications might lead to the development of the autoimmune condition need to be examined further.

Methods- An epidemiological study using the UK primary care database, and the associated pregnancy register was using to describe the annual prevalence of 17 autoimmune diseases in pregnant women (15-49 years) from 2000-2021. Logistic regression estimated odds ratios for the relationship between women's characteristics and autoimmune disease during pregnancy. The umbrella review summarised evidence on the association between these diseases and adverse pregnancy outcomes, using data from Medline, Embase, and Cochrane (up to December 2023). A population-based cohort study linked CPRD and HES data to assess the association between autoimmune diseases and pregnancy outcomes, using modified Poisson regression to estimate adjusted relative risks. Lastly, a systematic review explored the link between pregnancy complications and development of autoimmune diseases in women, with searches in Medline, CINAHL, and Cochrane (up to January 2024).

Results- The prevalence of 17 autoimmune diseases increased from 3.5% in 2000 to 4.7% in 2021, with psoriasis the most common (1.8% to 2.0%). The steepest increases were in Hashimoto thyroiditis (0.05% to 0.12%), coeliac disease (0.11% to 0.27%), Grave’s disease (0.17% to 0.35%), and T1DM (0.14% to 0.49%). In the umbrella review including thirty-two reviews. Higher risk of miscarriage is reported in women with Sjögren’s syndrome RR 8.85 (95% CI 3.10-25.26). Pre-eclampsia was higher in women with T1DM OR 4.19 (3.08-5.71), GDM reported with IBD OR 2.96 (1.47-5.98). Increased risk of intrauterine growth restriction in women with systemic sclerosis OR 3.20 (2.21-4.53), preterm birth with T1DM OR 4.36 (3.72-5.12) or SLE OR 2.79 (2.07-3.77). Low birth weight babies in women with women with SLE or systemic sclerosis OR 5.95 (4.54-7.80) and higher risk of stillbirth in women with T1DM OR 3.97 (3.44-4.58). The cohort study (5,239,383 pregnancies, 2,057,150 birth) found hyperemesis in Addison’s disease aRR (3.72, 95% CI 2.48–5.59), ectopic pregnancy in rheumatoid arthritis (1.50, 1.21–1.86), miscarriage in Sjogren syndrome (1.36, 1.09–1.70), pre-eclampsia in T1DM (3.56, 3.32–3.82), GDM in Addison’s disease (2.52,1.35-4.68) caesarean birth in IBD (1.27, 1.22–1.31), small for gestational age in SLE (2.45, 1.65–3.62), preterm birth in rheumatoid arthritis (1.47, 1.29–1.67), and stillbirth in SLE (1.93, 1.10–3.39). Mental health outcomes were linked with most conditions. The systematic review including 30 studies reported that pregnancy complications increased the risk of autoimmune diseases RR 3.20 (2.90-3.51), and stillbirth was associated with composite autoimmune conditions RR 5.82 (4.87-6.81). Postpartum psychosis was linked to autoimmune thyroid disease IRR 2.26 (1.61-2.90).

Conclusion- The burden of pregnancies affected by autoimmune diseases is rising, with greater risk of adverse pregnancy outcomes. Women with pregnancy complications also face a higher risk of later autoimmune diagnoses. Further research is needed to improve care from preconception to postnatal stages and to investigate the links between autoimmune diseases and pregnancy outcomes.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):