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Preterm birth phenotypes in women with autoimmune rheumatic diseases: a population-based cohort study
K D Kolstad1, J A Mayo2, L Chung1,3
1Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Insights
Women with autoimmune diseases face higher risks for preterm birth (PTB) phenotypes. Close monitoring during pregnancy and preconception counseling are essential for managing these risks.
Area of Science:
- Rheumatology
- Obstetrics
- Epidemiology
Background:
- Autoimmune rheumatic diseases (ARDs) can impact pregnancy outcomes.
- Preterm birth (PTB) is a significant concern in obstetric care.
- Understanding PTB phenotypes in ARD patients is crucial for risk assessment.
Purpose of the Study:
- To investigate the association between different autoimmune rheumatic diseases and various preterm birth phenotypes.
- To quantify the risk of preterm birth in women with specific ARDs compared to the general population.
Main Methods:
- A retrospective cohort study analyzed over 2.4 million singleton births in California (2007-2011).
- Patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), polymyositis/dermatomyositis (DM/PM), and juvenile idiopathic arthritis (JIA) were identified.
- Multivariable Poisson regression models were used to estimate risk ratios for PTB phenotypes, adjusting for multiple covariates.
Main Results:
- Elevated risks for PTB were observed across all evaluated autoimmune diseases: SLE (RR 3.27), RA (RR 2.04), SSc (RR 3.74), JIA (RR 2.23), and DM/PM (RR 5.26).
- These increased risks were associated with various PTB phenotypes, including spontaneous, PPROM, and medically indicated preterm births.
- The elevated risks persisted across early and late preterm gestation categories.
Conclusions:
- Women with systemic autoimmune diseases exhibit a significantly elevated risk for diverse preterm birth phenotypes.
- Preconception counseling and enhanced prenatal monitoring are recommended for pregnant individuals with ARDs.
- Further research may elucidate specific mechanisms linking ARDs to adverse pregnancy outcomes.
Objective:
To investigate preterm birth (PTB) phenotypes in women with different autoimmune rheumatic diseases in a large population-based cohort.
Design:
Retrospective cohort study.
Setting:
California, USA.
Population:
All live singleton births in California between 2007 and 2011 were analysed. Patients with autoimmune disease at delivery were identified by International Classification of Diseases, Ninth Revision , Clinical Modification (ICD-9-CM), codes for systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), polymyositis/dermatomyositis (DM/PM), and juvenile idiopathic arthritis (JIA).
Methods:
Maternally linked hospital and birth certificate records of 2 481 516 deliveries were assessed (SLE n = 2272, RA n = 1501, SSc n = 88, JIA n = 187, DM/PM n = 38). Multivariable Poisson regression models estimated the risk ratios (RRs) for different PTB phenotypes (relative to term deliveries) for each autoimmune disease compared with the general obstetric population, adjusting for maternal age, race/ethnicity, body mass index, smoking, education, payer, parity, and prenatal care.
Main Outcome Measures:
Preterm birth (PTB) was assessed overall (20-36 weeks of gestation) and by subphenotype: preterm prelabour rupture of membranes (PPROM), spontaneous birth, or medically indicated PTB. The risk of PTB overall and for each phenotype was partitioned by gestational age: early (20-31 weeks of gestation) and late (32-36 weeks of gestation).
Results:
Risks for PTB were elevated for each autoimmune disease evaluated: SLE (RR 3.27, 95% CI 3.01-3.56), RA (RR 2.04, 95% CI 1.79-2.33), SSc (RR 3.74, 95% CI 2.51-5.58), JIA (RR 2.23, 95% CI 1.54-3.23), and DM/PM (RR 5.26, 95% CI 3.12-8.89). These elevated risks were observed for the majority of PTB phenotypes as well.
Conclusions:
Women with systemic autoimmune diseases appear to have an elevated risk of various PTB phenotypes. Therefore, preconception counselling and close monitoring during pregnancy is crucial.
Tweetable Abstract:
This study found that women with systemic autoimmune diseases have an elevated risk of preterm birth phenotypes.
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