Presented in part at the Society of Epidemiologic Research Meeting, June 2007, and the First Annual Symposium on Systemic Lupus Erythematosus at the Beth Israel Deaconess Medical Center, September 2007.
Systemic Lupus Erythematosus
Perinatal factors and adult-onset lupus†
Article first published online: 30 JUL 2008
Copyright © 2008 by the American College of Rheumatology
Arthritis Care & Research
Volume 59, Issue 8, pages 1155–1161, 15 August 2008
How to Cite
Simard, J. F., Karlson, E. W., Costenbader, K. H., HerNán, M. A., Stampfer, M. J., Liang, M. H. and Mittleman, M. A. (2008), Perinatal factors and adult-onset lupus. Arthritis & Rheumatism, 59: 1155–1161. doi: 10.1002/art.23930
- Issue published online: 30 JUL 2008
- Article first published online: 30 JUL 2008
- Manuscript Accepted: 18 MAR 2008
- Manuscript Received: 8 NOV 2007
- Arthritis Foundation Doctoral Dissertation Award
- NIH. Grant Numbers: grants R01-AR-49880, K24-AR0-52401, K12-HD0-51959
- Arthritis Foundation/American College of Rheumatology Arthritis Investigator Award
- NIH Multipurpose Arthritis Center Grant
- Arthritis Foundation
Some evidence suggests that perinatal factors, including birth weight and breastfeeding, may influence the occurrence of autoimmune rheumatic diseases. However, few studies have investigated these factors in patients with systemic lupus erythematosus (SLE). Therefore, we evaluated the role of birth weight, being breastfed, and preterm birth on the incidence of SLE in participants in the Nurses' Health Study (NHS) and the Nurses' Health Study II (NHSII).
We studied 87,411 NHS participants and 98,413 NHSII participants without SLE at baseline who provided information on perinatal exposures. Among these women, during 26 (NHS) and 14 (NHSII) years of followup, 222 incident SLE cases were confirmed (136 NHS and 86 NHSII) by medical record review using American College of Rheumatology criteria. We used stratified Cox models to estimate the association of perinatal factors with SLE, adjusting for race, early passive cigarette smoke exposure, and parents' occupation. A random-effects meta-analysis was used to compute combined estimates across the 2 cohorts.
After adjustment for multiple potential confounders, high birth weight (≥10 pounds) was associated with increased rates of SLE compared with normal birth weight (7–8.5 pounds; rate ratio [RR] 2.7, 95% confidence interval [95% CI] 1.2–5.9), as was being born ≥2 weeks preterm (RR 1.9, 95% CI 1.2–3.0); however, being breastfed was not (RR 0.8, 95% CI 0.6–1.1).
Birth weight ≥10 pounds and preterm birth were both positively associated with incident SLE among women.