Addison's disease in women is a risk factor for an adverse pregnancy outcome.
BACKGROUND
Autoimmune Addison's disease (AAD) tends to affect young and middle-aged women. It is not known whether the existence of undiagnosed or diagnosed AAD influences the outcome of pregnancy.


OBJECTIVE
The aim of the study was to compare the number of children and pregnancy outcomes in individuals with AAD and controls.


METHODS
We conducted a population-based historical cohort study in Sweden.


METHODS
Through the Swedish National Patient Register and the Total Population Register, we identified 1,188 women with AAD and 11,879 age-matched controls who delivered infants between 1973 and 2006.


METHODS
We measured parity and pregnancy outcome.


RESULTS
Adjusted odds ratios (ORs) for infants born to mothers with deliveries 3 yr or less before the diagnosis of AAD were 2.40 [95% confidence interval (CI), 1.27-4.53] for preterm birth (≤37 wk), 3.50 (95% CI, 1.83-6.67) for low birth weight (<2500 g), and 1.74 (95% CI, 1.02-2.96) for cesarean section. Compared to controls, women who gave birth after their AAD diagnosis were at increased risk of both cesarean delivery (adjusted OR, 2.35; 95% CI, 1.68-3.27) and preterm delivery (adjusted OR, 2.61; 95% CI, 1.69-4.05). Stratifying by isolated AAD and concomitant type 1 diabetes and/or autoimmune thyroid disease in the mother did not essentially influence these risks. There were no differences in risks of congenital malformations or infant death. Women with AAD had a reduced overall parity compared to controls (P<0.001).


CONCLUSIONS
Clinically undiagnosed and diagnosed AAD both entail increased risks of unfavorable pregnancy outcomes. AAD also influences the number of childbirths.
Björnsdottir
Sigridur
S
Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden. Sigridur.Bjornsdottir@karolinska.se
Cnattingius
Sven
S
Brandt
Lena
L
Nordenström
Anna
A
Ekbom
Anders
A
Kämpe
Olle
O
Bensing
Sophie
S
D000224:Addison Disease / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000401:mortality; D000293:Adolescent; D000303:Adrenal Cortex Diseases / Q000150:complications; D000328:Adult; D001724:Birth Weight; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008875:Middle Aged; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012042:Registries; D018570:Risk Assessment; D013548:Sweden / Q000453:epidemiology