Background Autoimmune diseases disproportionately impact women and female-specific aspects of reproduction are thought to play a role. We investigated the time-varying association between pregnancy complications and new-onset autoimmune disease in females during the reproductive and midlife years. Methods We conducted a population-based cohort study of 1 704 553 singleton births to 1 072 445 females in Ontario, Canada (2002–17) with no pre-existing autoimmune disease. Pregnancy complications were preeclampsia, stillbirth, spontaneous preterm birth and severe small for gestational age (SGA). Royston-Parmar models were used to estimate the time-varying association between pregnancy complications and a composite of 25 autoimmune diseases from date of delivery to date of autoimmune disease diagnosis or censoring at death, loss of health insurance, or 31 March 2021. Models were adjusted for baseline socio-demographics, parity and comorbidities. Results At 19 years (median = 10.9 years of follow-up), cumulative incidence of autoimmune disease was 3.1% in those with a pregnancy complication and 2.6% in those without complications. Adjusted hazard ratio (AHR) curves as a function of time since birth were generally L-shaped. Universally, risks were most elevated within the first 3 years after birth [at 1 year: preeclampsia AHR 1.22, 95% confidence interval (CI) 1.09–1.36; stillbirth AHR 1.36, 95% CI 0.99–1.85; spontaneous preterm birth AHR 1.30, 95% CI 1.18–1.44; severe SGA AHR 1.14, 95% CI 0.99–1.31] and plateaued but remained elevated thereafter. Conclusions Prior history of pregnancy complications may be an important female-specific risk factor to consider during clinical assessment of females for possible autoimmune disease to facilitate timely detection and treatment.

中文翻译：

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妊娠并发症和新发母体自身免疫性疾病


背景 自身免疫性疾病对女性的影响不成比例，而女性特有的生殖方面被认为起着一定的作用。我们调查了女性育龄和中年时期妊娠并发症与新发自身免疫性疾病之间的时变关联。方法 我们进行了一项基于人群的队列研究，研究了加拿大安大略省 （2002-17） 的 1 704 553 名单胎婴儿到 1 072 445 名没有自身免疫性疾病的女性。妊娠并发症为子痫前期、死产、自发性早产和严重小于胎龄儿 （SGA）。Royston-Parmar 模型用于估计妊娠并发症与 25 种自身免疫性疾病复合之间的时变关联，从分娩之日到自身免疫性疾病诊断或死亡、失去健康保险或 2021 年 3 月 31 日被排除之日。根据基线社会人口统计学、胎次和合并症调整模型。结果 在 19 岁时 （中位 = 10.9 年的随访），有妊娠并发症的患者自身免疫性疾病的累积发病率为 3.1%，无并发症的患者为 2.6%。作为自出生以来时间的函数，调整后的风险比 （AHR） 曲线通常为 L 形。一般来说，出生后前 3 年内风险最高 [1 岁：子痫前期 AHR 1.22,95% 置信区间 （CI） 1.09–1.36;死产 AHR 1.36,95% CI 0.99–1.85;自发性早产 AHR 1.30,95% CI 1.18–1.44;重度 SGA AHR 1.14,95% CI 0.99–1.31]并趋于稳定，但此后保持升高。结论 妊娠并发症既往史可能是临床评估女性可能的自身免疫性疾病时需要考虑的重要女性特异性危险因素，以便于及时发现和治疗。