Goulden, Bethan;
Woodward, George;
Leiner, Sophie;
Ahmed, Zahra;
Covington, Sophie;
Nzelu, Diane;
Dolhain, Radboud;
(2025)
The impact of pregnancy on future health in Rheumatoid Arthritis: A systematic review of the literature.
Autoimmunity Reviews
, 24
(7)
, Article 103808. 10.1016/j.autrev.2025.103808.
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Abstract
OBJECTIVES: To assess whether obstetric history predicts future rheumatoid arthritis (RA) diagnosis, severity, and/or maternal health beyond the immediate postpartum period. METHODS: A systematic literature search was conducted on 01/07/24 (PubMed, Embase); PROSPERO ID CRD42024559893. Primary research examining health outcomes in RA-affected females, stratified on obstetric history pre- or post-RA onset, were selected for inclusion. Studies of overlapping cohorts were included if differing exposures/outcomes reported. RESULTS: Out of 3333 articles screened, 95 studies were selected. Future health outcomes analysed included RA diagnosis (n = 66 studies), severity (n = 11), cardiovascular disease (n = 2), immunity (n = 9), and microchimerism (n = 7). Parity/gravidity (n = 67), infertility (n = 7), and pregnancy loss (n = 22) were not reliable predictors of subsequent RA. High parity (n = 2) was linked to increased cardiovascular disease risk in RA-affected females. Both pre-eclampsia (n = 4) and delivery of a low birthweight infant (n = 2) were associated with RA diagnosis/severity. A trend suggested increased RA risk after preterm birth (n = 3) and severe hyperemesis gravidarum (n = 3), but not for gestational diabetes (n = 1). No significant differences in post-translational modification of serum proteins were noted beyond 6 months postpartum, though persistent differences in anti-HLA antibodies and microchimerism were observed. CONCLUSIONS: Research indicates that parity, gravidity, infertility, and pregnancy loss do not adversely affect RA development. Conversely, low birthweight delivery was associated with RA diagnosis and severity, while pre-eclampsia correlated with subsequent RA diagnosis. Differences in immune responses, as indicated by anti-HLA and microchimerism, may indicate immune sensitisation relevant to RA pathogenesis. The predictive impact of pre-eclampsia and gestational diabetes on cardiovascular health in RA-affected females remains unstudied.
| Type: | Article |
|---|---|
| Title: | The impact of pregnancy on future health in Rheumatoid Arthritis: A systematic review of the literature |
| Location: | Netherlands |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.autrev.2025.103808 |
| Publisher version: | https://doi.org/10.1016/j.autrev.2025.103808 |
| Language: | English |
| Additional information: | © 2025 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
| Keywords: | Rheumatoid arthritis, Pregnancy, Parity, Diagnosis, Progression |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10209787 |
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