Addison’s Disease for an Adverse Pregnancy

Addison’s Disease in Women Is a Risk Factor for an Adverse Pregnancy Outcome

Sigridur Björnsdottir, Sven Cnattingius, Lena Brandt, Anna Nordenström, Anders Ekbom, Olle Kämpe and Sophie Bensing

Departments of Molecular Medicine and Surgery (S.Bj., S.Be.) and Clinical Epidemiology Unit (S.C., L.B., A.E.), Department of Medicine, Karolinska Institutet, 171 76 Stockholm, Sweden; Department of Pediatrics (A.N.), Karolinska University Hospital, 14 186 Huddinge, Sweden; and Department of Medical Sciences (O.K., S.Be.), Uppsala University, 751 85 Uppsala, Sweden

Address all correspondence and requests for reprints to: Sigridur Björnsdottir, Department of Molecular Medicine and Surgery, Karolinska Institutet, D2:04 Karolinska University Hospital, 171 76 Stockholm, Sweden. E-mail: Sigridur.Bjornsdottir@karolinska.se.

Context: Autoimmune Addison’s disease (AAD) tends to affect young and middle-aged women. It is not known whether the existence of undiagnosed or diagnosed AAD influences the outcome of pregnancy.

Objective: The aim of the study was to compare the number of children and pregnancy outcomes in individuals with AAD and controls.

Design and Setting: We conducted a population-based historical cohort study in Sweden.

Patients: Through the Swedish National Patient Register and the Total Population Register, we identified 1,188 women with AAD and 11,879 age-matched controls who delivered infants between 1973 and 2006.

Main Outcome Measures: We measured parity and pregnancy outcome.

Results: Adjusted odds ratios (ORs) for infants born to mothers with deliveries 3 yr or less before the diagnosis of AAD were 2.40 [95% confidence interval (CI), 1.27–4.53] for preterm birth (≤37 wk), 3.50 (95% CI, 1.83–6.67) for low birth weight (<2500 g), and 1.74 (95% CI, 1.02–2.96) for cesarean section. Compared to controls, women who gave birth after their AAD diagnosis were at increased risk of both cesarean delivery (adjusted OR, 2.35; 95% CI, 1.68–3.27) and preterm delivery (adjusted OR, 2.61; 95% CI, 1.69–4.05). Stratifying by isolated AAD and concomitant type 1 diabetes and/or autoimmune thyroid disease in the mother did not essentially influence these risks. There were no differences in risks of congenital malformations or infant death. Women with AAD had a reduced overall parity compared to controls (P < 0.001).

Conclusion: Clinically undiagnosed and diagnosed AAD both entail increased risks of unfavorable pregnancy outcomes. AAD also influences the number of childbirths.