{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:21:40Z","timestamp":1788351700380,"version":"build-2803163510"},"reference-count":42,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Mutuelle G\u00e9n\u00e9rale de l\u2019Education Nationale"},{"DOI":"10.13039\/501100001665","name":"National Research Agency","doi-asserted-by":"crossref","award":["ANR-10-COHO-0006"],"award-info":[{"award-number":["ANR-10-COHO-0006"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100031376","name":"Soci\u00e9t\u00e9 Fran\u00e7aise de Rhumatologie","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100031376","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Gustave Roussy Institute"},{"DOI":"10.13039\/501100004099","name":"French League against Cancer","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004099","id-type":"DOI","asserted-by":"crossref"}]},{"name":"FOREUM Foundation for Research in Rheumatology"},{"DOI":"10.13039\/100020552","name":"Ministry of Higher Education, Research and Innovation","doi-asserted-by":"publisher","award":["2103236497"],"award-info":[{"award-number":["2103236497"]}],"id":[{"id":"10.13039\/100020552","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020552","name":"Ministry of Higher Education, Research and Innovation","doi-asserted-by":"publisher","award":["2103586016"],"award-info":[{"award-number":["2103586016"]}],"id":[{"id":"10.13039\/100020552","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020552","name":"Ministry of Higher Education, Research and Innovation","doi-asserted-by":"publisher","award":["N\u00b02102918823"],"award-info":[{"award-number":["N\u00b02102918823"]}],"id":[{"id":"10.13039\/100020552","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,1,8]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine associations between participants\u2019 perinatal factors, including harmonised birth weight and length, prematurity, exposure to maternal smoking during pregnancy and breastfeeding during infancy, and incident rheumatoid arthritis (RA) in a large prospective cohort of French women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Etude Epid\u00e9miologique aupr\u00e8s des femmes de la Mutuelle g\u00e9n\u00e9rale de l\u2019\u00c9ducation Nationale (E3N) cohort enrolled 98\u2009995\u2009women in 1990. Perinatal data were collected in 2002. Birth weight and length were reported continuously and\/or categorically and harmonised according to term status. RA cases were validated using a specific questionnaire. Adjusted HRs (aHRs) and 95% CIs were estimated using Cox proportional hazards models informed by a directed acyclic graph.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 78\u2009473\u2009women, 698 incident RA cases were identified. No evidence of an association was observed between perinatal factors and RA risk in the overall population. Point estimates for large birth length (aHR 1.32, 95% CI 0.97 to 1.78) and preterm birth (aHR 1.34, 95% CI 0.92 to 1.94) were above 1, but CIs included the null value of 1.<\/jats:p>\n                    <jats:p>In sensitivity analyses restricted to women with continuous birth data, a signal for large birth length was observed (aHR 1.98, 95% CI 1.23 to 3.19), whereas no such signal was detected when using categorised self-reported measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this large prospective cohort, most perinatal factors were not associated with RA risk in adulthood. A signal related to larger birth length emerged only in selected analyses based on more precise exposure assessment and should be interpreted cautiously. These findings are hypothesis-generating and warrant replication in independent cohorts using prospectively measured perinatal data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03285230\">NCT03285230<\/jats:ext-link>\n                      <\/jats:bold>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-006415","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T16:15:20Z","timestamp":1775751320000},"page":"e006415","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Birth length and perinatal exposures and rheumatoid arthritis risk in the E3N cohort"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct03285230","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03285230","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8118-0848","authenticated-orcid":false,"given":"Perrine","family":"Dusser","sequence":"first","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Universit\u00e9 Paris-Sud, Centre for Research in Epidemiology and Population Health (CESP), \u2018Exposome and Heredity\u2019 Team, Institut pour la Sant\u00e9 et la Recherche M\u00e9dicale (INSERM), Gustave Roussy, Villejuif, France"},{"name":"Pediatric Rheumatology Department, Assistance Publique-H\u00f4pitaux de Paris (AP-HP), H\u00f4pitaux universitaires Paris-Sud \u2013 H\u00f4pital Bic\u00eatre, Le Kremlin-Bic\u00eatr, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0866-3824","authenticated-orcid":false,"given":"Yann","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, AP-HP-H\u00f4pital Beaujon, Paris University, Clichy, France"},{"name":"Centre de recherche en immunologie des maladies, INSERM U1184, Universit\u00e9 Paris Saclay, Le Kremlin-Bic\u00eatre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Perrin","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Universit\u00e9 Paris-Sud, Centre for Research in Epidemiology and Population Health (CESP), \u2018Exposome and Heredity\u2019 Team, Institut pour la Sant\u00e9 et la Recherche M\u00e9dicale (INSERM), Gustave Roussy, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline","family":"Fr\u00e9noy","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Universit\u00e9 Paris-Sud, Centre for Research in Epidemiology and Population Health (CESP), \u2018Exposome and Heredity\u2019 Team, Institut pour la Sant\u00e9 et la Recherche M\u00e9dicale (INSERM), Gustave Roussy, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4244-5417","authenticated-orcid":false,"given":"Xavier","family":"Mariette","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Assistance Publique-H\u00f4pitaux de Paris (AP-HP), H\u00f4pitaux universitaires Paris-Sud \u2013 H\u00f4pital Bic\u00eatre, Le Kremlin-Bic\u00eatre, Paris, France"},{"name":"Universit\u00e9 Paris-Saclay, Center of Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Sant\u00e9 et la Recherche M\u00e9dicale (INSERM) U1184, Le Kremlin-Bic\u00eatre, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Christine","family":"Boutron-Ruault","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Universit\u00e9 Paris-Sud, Centre for Research in Epidemiology and Population Health (CESP), \u2018Exposome and Heredity\u2019 Team, Institut pour la Sant\u00e9 et la Recherche M\u00e9dicale (INSERM), Gustave Roussy, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Severi","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Universit\u00e9 Paris-Sud, Centre for Research in Epidemiology and Population Health (CESP), \u2018Exposome and Heredity\u2019 Team, Institut pour la Sant\u00e9 et la Recherche M\u00e9dicale (INSERM), Gustave Roussy, Villejuif, France"},{"name":"Department of Statistics, Computer Science, Applications \u2018G. 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