{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:06:02Z","timestamp":1768565162542,"version":"3.49.0"},"posted":{"date-parts":[[2023,8,9]]},"group-title":"Health Informatics","reference-count":30,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2023,8,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Immune-mediated inflammatory diseases (IMIDs) are likely to complicate maternal health. However, literature data on patients with IMIDs undergoing pregnancy is scarce and often overlooks the impact of comorbidities.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We investigated 12 selected IMIDs: psoriasis, inflammatory bowel disease, rheumatoid arthritis, spondyloarthritis, multiple sclerosis, systemic lupus erythematosus, psoriatic arthritis, antiphospholipid syndrome, Sj\u00f6gren\u2019s syndrome, vasculitis, sarcoidosis, systemic sclerosis. We characterized patients with IMIDs prior to pregnancy (IMIDs group) based on pregnancy\/maternal characteristics, comorbidities, and pre-pregnancy\/prenatal immunomodulatory medications (IMMs) prescription patterns. We 1:1 propensity score matched the IMIDs cohort with people who had no IMID diagnoses prior to pregnancy (non-IMIDs cohort). Outcome measures were preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA), and cesarean section.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>The prevalence rate of pregnancy occurring with people with a previous IMID diagnosis has doubled in the past ten years. We identified 5,784 patients with IMIDs. 17% of the IMIDs group had at least one prenatal IMM prescription. Depending on the type of IMM, from 48% to 70% of the patients taking IMMs before pregnancy continued them throughout pregnancy. Patients with IMIDs had similar but slightly increased risks of PTB (Relative risk (RR)=1\u00b71[1\u00b70, 1\u00b73]), LBW (RR=1\u00b72 [1\u00b70,1\u00b74]), SGA (RR=1\u00b71 [1\u00b70,1\u00b72]), and cesarean section (RR=1\u00b71 [1\u00b71,1\u00b72]) compared to a matched cohort of people without IMIDs. Out of the 12 selected IMIDs, three for PTB, one for LBW, two for SGA, and six for cesarean section had results supporting increased risk.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Interpretation<\/jats:title>\n                  <jats:p>The association between IMIDs and the increased risk of adverse pregnancy outcomes depend on both the nature of the IMID and the presence of comorbidities.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Funding<\/jats:title>\n                  <jats:p>NIH<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2023.08.07.23293726","type":"posted-content","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T02:22:29Z","timestamp":1691720549000},"source":"Crossref","is-referenced-by-count":1,"title":["Maternal-fetal outcomes in patients with immune mediated inflammatory diseases, with consideration of comorbidities: a retrospective cohort study in a large U.S. healthcare system"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4193-8623","authenticated-orcid":false,"given":"Yeon Mi","family":"Hwang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1481-2304","authenticated-orcid":false,"given":"Qi","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8119-6724","authenticated-orcid":false,"given":"Samantha N.","family":"Piekos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7031-8116","authenticated-orcid":false,"given":"Bhargav","family":"Vemuri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8227-4416","authenticated-orcid":false,"given":"Sevda","family":"Molani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Mease","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7158-3678","authenticated-orcid":false,"given":"Leroy","family":"Hood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6103-7606","authenticated-orcid":false,"given":"Jennifer J.","family":"Hadlock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2023081114052661000_2023.08.07.23293726v1.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-021-00603-1"},{"key":"2023081114052661000_2023.08.07.23293726v1.2","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2006.052688"},{"key":"2023081114052661000_2023.08.07.23293726v1.3","doi-asserted-by":"publisher","DOI":"10.1006\/clin.1997.4412"},{"key":"2023081114052661000_2023.08.07.23293726v1.4","unstructured":"MacGregor AJ , Silman AJ . Rheumatoid arthritis and other synovial disorders: classification and epidemiology. Rheumatology. 2003;"},{"issue":"7","key":"2023081114052661000_2023.08.07.23293726v1.5","first-page":"1421","article-title":"Inflammatory bowel disease prevalence by age, gender, race, and geographic location in the U","volume":"19","year":"2013","journal-title":"S. military health care population. Inflamm Bowel Dis"},{"key":"2023081114052661000_2023.08.07.23293726v1.6","doi-asserted-by":"publisher","DOI":"10.1177\/1352458511403794"},{"key":"2023081114052661000_2023.08.07.23293726v1.7","doi-asserted-by":"publisher","DOI":"10.1002\/art.22641"},{"key":"2023081114052661000_2023.08.07.23293726v1.8","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204838"},{"issue":"1","key":"2023081114052661000_2023.08.07.23293726v1.9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s13293-017-0146-6","article-title":"Long-term follow-up in primary Sj\u00f6gren\u2019s syndrome reveals differences in clinical presentation between female and male patients","volume":"8","year":"2017","journal-title":"Biol Sex Differ"},{"issue":"2","key":"2023081114052661000_2023.08.07.23293726v1.10","doi-asserted-by":"crossref","first-page":"rky041","DOI":"10.1093\/rap\/rky041","article-title":"Risk factors for the development of systemic sclerosis: a systematic review of the literature","volume":"2","year":"2018","journal-title":"Rheumatol Adv Pract"},{"issue":"9","key":"2023081114052661000_2023.08.07.23293726v1.11","first-page":"145","article-title":"Pregnancy and Autoimmune Disease","volume":"119","year":"2022","journal-title":"Dtsch Arztebl Int"},{"key":"2023081114052661000_2023.08.07.23293726v1.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103334"},{"key":"2023081114052661000_2023.08.07.23293726v1.13","doi-asserted-by":"crossref","unstructured":"Fazzari MJ , Guerra MM , Salmon J , Kim MY . Adverse pregnancy outcomes in women with systemic lupus erythematosus: can we improve predictions with machine learning? Lupus Sci Med [Internet]. 2022 Sep;9(1). Available from: http:\/\/dx.doi.org\/10.1136\/lupus-2022-000769","DOI":"10.1136\/lupus-2022-000769"},{"issue":"6","key":"2023081114052661000_2023.08.07.23293726v1.14","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1177\/0961203316686704","article-title":"Systemic lupus erythematosus and risk of preterm birth: a systematic review and meta-analysis of observational studies","volume":"26","year":"2017","journal-title":"Lupus"},{"key":"2023081114052661000_2023.08.07.23293726v1.15","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2018-000878"},{"key":"2023081114052661000_2023.08.07.23293726v1.16","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2006.108324"},{"issue":"3","key":"2023081114052661000_2023.08.07.23293726v1.17","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s10067-022-06436-0","article-title":"Maternal and fetal outcomes in pregnant women with rheumatoid arthritis: a systematic review and meta-analysis","volume":"42","year":"2023","journal-title":"Clin Rheumatol"},{"key":"2023081114052661000_2023.08.07.23293726v1.18","doi-asserted-by":"publisher","DOI":"10.1080\/08820130802205886"},{"key":"2023081114052661000_2023.08.07.23293726v1.19","doi-asserted-by":"publisher","DOI":"10.1002\/ibd.20082"},{"key":"2023081114052661000_2023.08.07.23293726v1.20","doi-asserted-by":"crossref","first-page":"265","DOI":"10.2147\/IJWH.S90157","article-title":"Systemic lupus erythematosus: strategies to improve pregnancy outcomes","volume":"8","year":"2016","journal-title":"Int J Womens Health"},{"key":"2023081114052661000_2023.08.07.23293726v1.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2017.07.015"},{"key":"2023081114052661000_2023.08.07.23293726v1.22","unstructured":"U.S. Census Bureau. Stable Fertility Rates 1990-2019 Mask Distinct Variations by Age [Internet]. [cited 2023 Apr 26]. Available from: https:\/\/www.census.gov\/library\/stories\/2022\/04\/fertility-rates-declined-for-younger-women-increased-for-older-women.html?utm_campaign=20220406msacos1ccstors&utm_medium=email&utm_source=govdelivery"},{"key":"2023081114052661000_2023.08.07.23293726v1.23","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-219373"},{"key":"2023081114052661000_2023.08.07.23293726v1.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.coi.2022.102266"},{"key":"2023081114052661000_2023.08.07.23293726v1.25","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1186\/s12887-015-0532-3","article-title":"Maternal and neonatal outcomes in pregnant women with autoimmune diseases in Pavia, Italy","volume":"15","year":"2015","journal-title":"BMC Pediatr"},{"issue":"5","key":"2023081114052661000_2023.08.07.23293726v1.26","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/j.jaad.2018.02.036","article-title":"Pregnancy outcomes in patients with vitiligo: A nationwide population-based cohort study from Korea","volume":"79","year":"2018","journal-title":"J Am Acad Dermatol"},{"key":"2023081114052661000_2023.08.07.23293726v1.27","doi-asserted-by":"crossref","first-page":"102676","DOI":"10.1016\/j.jaut.2021.102676","article-title":"Pregnancy and neonatal outcomes in women with immune mediated inflammatory diseases exposed to anti-tumor necrosis factor-\u03b1 during pregnancy: A systemic review and meta-analysis","volume":"122","year":"2021","journal-title":"J Autoimmun"},{"issue":"6","key":"2023081114052661000_2023.08.07.23293726v1.28","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1007\/s00404-022-06463-x","article-title":"Pregnant women with immune mediated inflammatory diseases who discontinue biologics have higher rates of disease flare","volume":"306","year":"2022","journal-title":"Arch Gynecol Obstet"},{"key":"2023081114052661000_2023.08.07.23293726v1.29","doi-asserted-by":"publisher","DOI":"10.1002\/art.24003"},{"issue":"5","key":"2023081114052661000_2023.08.07.23293726v1.30","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1093\/ecco-jcc\/jjaa225","article-title":"The Influence of Disease Activity on Pregnancy Outcomes in Women With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis","volume":"15","year":"2021","journal-title":"J Crohns Colitis"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2023.08.07.23293726","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T19:38:40Z","timestamp":1768505920000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2023.08.07.23293726"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,9]]},"references-count":30,"URL":"https:\/\/doi.org\/10.1101\/2023.08.07.23293726","relation":{"is-preprint-of":[{"id-type":"doi","id":"10.1016\/j.eclinm.2024.102435","asserted-by":"subject"}]},"subject":[],"published":{"date-parts":[[2023,8,9]]},"subtype":"preprint"}}