Background: Many studies have investigated the impact on pregnancy outcomes of the more common autoimmune diseases, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However only a few small case-control studies or case series have assessed the impact of other autoimmune diseases. The aim of this study was to examine pregnancy outcomes among women with rare autoimmune diseases.
Methods: We undertook a population-based cohort study of women giving birth in New South Wales from 2001 through 2011. Linked birth and hospital records were used to identify women with rare autoimmune diseases including Sjogren’s syndrome, systemic sclerosis, Behcet’s disease, systemic vasculitis, vasculitis limited to skin, dermatopolymyositis and other systemic involvement of connective tissue. Women with SLE or RA were excluded, as were women whose first record (hospitalisation) of an autoimmune disease occurred more than 6 months after the birth. Modified Poisson regression was used to compare study outcomes between women with autoimmune diseases and the general maternity population.
Results: There were 991,701 births including 409 (0.04%) births to 293 women with rare autoimmune diseases. Of the 409 births, 202 (49%) delivered by caesarean section and 72 (18%) were preterm; these rates were significantly higher than those in the general maternity population (28% and 7% respectively). Compared to the general maternity population, women with autoimmune diseases had higher rates of hypertensive disorders, antepartum haemorrhage and severe maternal morbidity, and required longer hospitalisation at delivery, more hospital admissions and tertiary obstetric care. Compared to other infants, those whose mothers had a rare autoimmune disease were at increased risk of admission to neonatal intensive care unit, severe neonatal morbidity and perinatal death.
Conclusion: While the majority of women with rare autoimmune diseases delivered healthy infants, they were at increased risk of having both maternal complications and adverse neonatal outcomes suggesting their pregnancies should be closely monitored.