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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妊娠并发症和新发孕产妇自身免疫性疾病。


背景技术自身免疫性疾病对女性的影响尤为严重，并且女性特有的生殖方面被认为发挥了一定作用。我们调查了育龄期和中年女性妊娠并发症与新发自身免疫性疾病之间随时间变化的关联。方法 我们对加拿大安大略省（2002-17 年）的 1 704 553 名单胎新生儿和 1 072 445 名女性进行了一项基于人群的队列研究，这些女性没有既往患有自身免疫性疾病。妊娠并发症包括先兆子痫、死产、自发性早产和严重小于胎龄（SGA）。 Royston-Parmar 模型用于估计妊娠并发症与 25 种自身免疫性疾病之间的时变关联，从分娩日期到自身免疫性疾病诊断日期或死亡、失去健康保险或 2021 年 3 月 31 日的审查日期。模型为根据基线社会人口统计、奇偶性和合并症进行调整。结果 19 岁时（中位随访时间为 10.9 年），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的调整风险比 (AHR) 曲线通常呈 L 形。一般来说，出生后前 3 年内风险最高[1 年时：先兆子痫 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；严重 SGA AHR 1.14，95% CI 0.99-1.31] 并趋于稳定，但此后仍保持升高。结论 在对女性可能的自身免疫性疾病进行临床评估时，妊娠并发症史可能是一个重要的女性特有危险因素，以便及时发现和治疗。