Hormonal and reproductive risk factors for development of systemic lupus erythematosus: results of a population-based, case-control study.
OBJECTIVE
Estrogen and prolactin may accelerate the progression of murine systemic lupus erythematosus (SLE). In humans, 85% of lupus patients are women, which also suggests the importance of hormonal factors in disease pathogenesis. The purpose of this study was to examine hormonal and reproductive risk factors for lupus among women.


METHODS
This population-based, case-control study included 240 female SLE patients diagnosed between January 1, 1995 and July 31, 1999 who fulfilled the American College of Rheumatology classification criteria. Female controls (n = 321) were identified through driver's license records. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) as measures of association, adjusting for age, state, race, and education. Analyses were limited to exposures before diagnosis.


RESULTS
Breast-feeding was associated with a decreased risk of developing SLE (OR 0.6, 95% CI 0.4-0.9), with a statistically significant trend for number of babies breast-fed and total weeks of breast-feeding. There were no associations with number of pregnancies or live births. Natural menopause occurred earlier in women with subsequent development of SLE compared with controls (P < 0.001). There was little association between SLE and current use or duration of use of hormone replacement therapy or oral contraceptives, and no association with previous use of fertility drugs.


CONCLUSIONS
We found little evidence that estrogen- or prolactin-related exposures are associated with an increased risk of lupus. The reduced risk observed among women who had breast-fed one or more babies should be examined in other studies. Early natural menopause, rather than decreasing risk of SLE because of reduced estrogen exposure, may be a marker of susceptibility to development of SLE.
Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina 27709, USA. cooper1@niehs.nih.gov
Glinda S
GS
Cooper
Mary Anne
MA
Dooley
Edward L
EL
Treadwell
E William
EW
St Clair
Gary S
GS
Gilkeson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001942:Breast Feeding; D016022:Case-Control Studies; D016001:Confidence Intervals; D003276:Contraceptives, Oral / Q000494:pharmacology; D004967:Estrogens / Q000502:physiology*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000209:etiology*; D008593:Menopause / Q000502:physiology; D008598:Menstruation; D008875:Middle Aged; D016017:Odds Ratio; D011247:Pregnancy; D011388:Prolactin / Q000502:physiology*; D012307:Risk Factors
D003276:Contraceptives, Oral; D004967:Estrogens; D011388:Prolactin