{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:15:09Z","timestamp":1791890109265,"version":"4.3.4"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,1,9]],"date-time":"2020-01-09T00:00:00Z","timestamp":1578528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Autoimmune conditions are associated with an increased risk of adverse pregnancy complications and outcomes, suggesting that pregnancy complications may mediate the excess risk. We performed a causal mediation analysis to quantify the mediated effects of autoimmune conditions on adverse pregnancy outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We queried a California birth cohort created from linked birth certificates and hospital discharge summaries. From 2,963,888 births, we identified women with rheumatoid arthritis (<jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>), systemic lupus erythematosus (<jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content>), psoriasis, and inflammatory bowel disease (<jats:styled-content style=\"fixed-case\">IBD<\/jats:styled-content>). Pregnancy complications included preeclampsia\/hypertension, gestational diabetes mellitus, and infection in pregnancy. Adverse pregnancy outcomes were preterm birth, cesarean delivery, and small for gestational age. We performed a mediation analysis to estimate the total effects of each autoimmune condition and adverse pregnancy outcome and the indirect effects through pregnancy complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All 4 autoimmune conditions were associated with preterm birth and cesarean delivery, and <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> SLE<\/jats:styled-content>, and <jats:styled-content style=\"fixed-case\">IBD<\/jats:styled-content> were associated with offspring that were small for gestational age. The strongest mediator of <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> SLE<\/jats:styled-content>, and psoriasis was preeclampsia\/hypertension, accounting for 20\u201333% of the excess risk of preterm births and 10\u201319% of excess cesarean deliveries. Gestational diabetes mellitus and infections generally mediated &lt;10% of excess adverse pregnancy outcomes. Of the 4 autoimmune conditions, selected pregnancy complications mediated the least number of adverse pregnancy outcomes among women with <jats:styled-content style=\"fixed-case\">IBD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found evidence that some excess risk of adverse pregnancy outcomes is mediated through pregnancy complications, particularly preeclampsia\/hypertension. Quantifying excess risk and associated pathways provides insight into the underlying etiologies of adverse pregnancy outcomes and can inform intervention strategies.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24037","type":"journal-article","created":{"date-parts":[[2019,8,2]],"date-time":"2019-08-02T11:14:35Z","timestamp":1564744475000},"page":"256-264","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Mediation of Adverse Pregnancy Outcomes in Autoimmune Conditions by Pregnancy Complications: A Mediation Analysis of Autoimmune Conditions and Adverse Pregnancy Outcomes"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2167-8921","authenticated-orcid":false,"given":"Gretchen","family":"Bandoli","sequence":"first","affiliation":[{"name":"University of California  San 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