Higher Rates of Childlessness in Rheumatic Diseases Save

A large Finnish population study shows that several rheumatic diseases may impair reproduction and pregnancy outcomes, with significantly higher rates of childlessness or fewer children overall for women.

A nationwide cohort study of 5 339 804 Finnish citizens, born 1964–1984, examined those with 19 immune-mediated diseases (IMDs). Each IMDs was matched with 20 controls (birth year, sex, education) looking reproductive success and adverse maternal and perinatal outcomes.

Several of the rheumatic diseases, particularly SLE, JIA, and seropositive RA, were associated with higher rates of childlessness and fewer children.  RA, JIA and SLE had fewer children than controls. 

Overall, only a few IMDs had higher risks of miscarriage (hypothyroidism [OR 1.12], and asthma [OR 1.11}, while multiple sclerosis (OR 0.80, 0.69–0.93) and seronegative RA (OR 0.76, 0.62–0.92) were associated with a decreased risk.

The risks for pre-eclampsia, newborns being small for gestational age, preterm delivery, non-elective Caesarean sections, and need of neonatal intensive care were increased in many IMDs. Particularly, SLE, SS, type 1 diabetes, and Addison’s disease showed >2-fold risks for some of these outcomes. In most rheumatic diseases, moderate (1.1–1.5-fold) risk increases were observed for diverse adverse pregnancy outcomes, with similar effects in IBD, celiac disease, asthma, ITP, and psoriasis.

Rheumatic diseases have a broad impact on reproductive health. SLE and Systemic Sclerosis conferred the largest risk increases on perinatal adverse event outcomes, but systematic evaluations across diseases are lacking.