The impact of abnormal autoimmune function on reproduction: maternal and fetal consequences.
The impact of abnormal autoimmune function on reproductive success has remained a highly controversial issue. This is, at least partially, due to the relative lack of demographic data from women with established autoimmune diseases. We, therefore, investigated 163 women with proven autoimmune diseases and 73 controls in a demographic study of reproductive success and impact of abnormal autoimmunity on pregnancy and offspring. Women with autoimmune diseases experienced fewer pregnancies overall (p=0.04) and fewer pregnancy losses (p=0.05). Offspring from women with autoimmune diseases demonstrated a significantly increased prevalence of confirmed autoimmune diseases (p=0.04; OR 3.759; 95%CL 1.04-1.27), which increased further if suspected, but not yet confirmed, cases were added (p=0.001; OR 8.592; 95%CL 1.05-55.0). Women with autoimmune diseases exhibited a trend towards lower cesarean section delivery during their own birth and a significantly increased prevalence of disease in vaginally delivered offspring (p=0.014; OR 6.041; 95%CL 1.32-38.22). Autoimmune diseases impair female fecundity even before the diseases become clinically overt. Offspring are at increased risk to develop autoimmune diseases, though they may differ from those of their mothers. This risk appears to correlate with mode of delivery and may be the consequence of varying cell traffic dynamics with vaginal and cesarean section deliveries.
Gleicher
Norbert
N
Centers for Human Reproduction (CHR), New York, NY 10021, USA. ngleicher@thechr.com
Weiner
Rebecca
R
Vietzke
Mary
M
D000328:Adult; D001327:Autoimmune Diseases / Q000150:complications* / Q000453:epidemiology*; D002585:Cesarean Section; D005260:Female; D005333:Fetus; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D015995:Prevalence; D012098:Reproduction / Q000502:physiology