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RESEARCH - Reproductive factors and risk of SLE: Denmark

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J Rheumatol. 2009 Jun 30.

Reproductive Factors and Risk of Systemic Lupus Erythematosus:

Nationwide Cohort Study in Denmark.

Ulff-Møller CJ, Jørgensen KT, Pedersen BV, Nielsen NM, Frisch M.

From the Department of Epidemiology Research, Statens Serum Institut,

Copenhagen, Denmark.

OBJECTIVE: The female predominance in systemic lupus erythematosus

(SLE) suggests the possible involvement of reproductive factors in its

etiology.We evaluated the relationship between parity and pregnancy

losses and subsequent risk of SLE in a population-based cohort study.

METHODS: We followed 4.4 million Danes aged 15-69 years for first

inpatient hospitalizations for SLE between 1977 and 2004. As measures

of relative risk, we used Poisson regression-derived hospitalization

rate ratios (RR) with 95% confidence intervals (CI) for cohort members

with different reproductive histories.

RESULTS: Overall, 1614 women and 274 men were hospitalized with SLE

during 88.9 million person years of followup. Number of children was

unrelated to SLE risk in men, but women with at least one liveborn

child were at lower risk than nulliparous women (RR 0.74; 95% CI

0.64-0.86), and women with 2 or more children were at lower risk than

1-child mothers. Recurrent idiopathic pregnancy losses, including

spontaneous abortions, missed abortions, and stillbirths, were

associated with markedly increased SLE risk (RR 3.50; 95% CI

2.38-4.96, for 2+ vs none; p < 0.001).

CONCLUSION: Nulliparous women, 1-child mothers, and women who

experience spontaneous abortions, missed abortions, or stillbirths are

at increased SLE risk. Theoretically, immunological processes involved

in subfertility or idiopathic pregnancy losses might act as initiating

or contributing factors in some cases of SLE. However, considering the

well established excess of pregnancy complications in women with

established SLE, the observed associations more likely reflect the

effect of subclinical immunological processes in women destined to

develop SLE.

PMID: 19567628

http://www.ncbi.nlm.nih.gov/pubmed/19567628

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