Original report
The Association between Gravidity and Primary Biliary Cirrhosis

https://doi.org/10.1016/S1047-2797(01)00277-0Get rights and content

Abstract

PURPOSE: Primary biliary cirrhosis is an autoimmune disease with female predominance that leads to liver failure. The goal of this study was to identify reproductive risk factors associated with this disease.

METHODS: We compared 182 cases of PBC with 225 age- and sex-matched friend controls to examine the role of reproductive factors. The survey instrument was developed using standardized questions obtained from the National Health and Nutrition Examination Survey (NHANES) III.

RESULTS: A total of 126/182 cases (69%) and 141/225 (62.6%) friend controls responded to the survey. More cases than controls reported ever having genitourinary infection [adjusted odds ratio (OR) = 2.12, 95% confidence interval (CI) 1.01, 4.42] among those without a personal or family history of autoimmune disease. The most notable finding was that cases reported significantly more pregnancies than controls (p = 0.008). The adjusted OR for each additional pregnancy among those without a personal or family history of autoimmune disease was 1.40 (95% CI 1.14, 1.7). More controls (24.4%) than cases (16.0%) were nulliparous. Cases reported having five or more children (16.0%) with double the frequency of controls (8.2%).

CONCLUSIONS: The association reported herein, between primary biliary cirrhosis and gravidity, is particularly significant because of the overwhelming female predominance.

Section snippets

Selected Abbreviations and Acronyms

PBC = primary biliary cirrhosis

NHANES = National Health and Nutrition Examination Survey

STD = sexually transmitted diseases

HMO = health maintenance organization

RA = rheumatoid arthritis

OC = oral contraceptive

GVHD = chronic graft versus host disease

Study Population and Data Collection

The details of enrollment of the study population and disease verification as well as the description of the survey instrument for the present analyses have been previously described in detail (19). Briefly, the sample for the present analysis was comprised of female PBC cases identified from an Internet support group and their age- and gender-matched friend controls.

The questionnaire was developed using a series of standardized questions drawn from the NHANES (20). The survey instrument

Demographic Characteristics

A total of 126 PBC cases out of the 182 contacted (69%) responded to the second survey. A total of 141 of the 225 friends named by the cases responded to the survey, for a response rate of 62.6%. As mentioned previously, the present analysis was restricted to the 119 female cases and 134 female controls for whom complete data were available. The mean age of the respondents was 53 years for cases and 54 years for controls (Table 1).

Approximately 98% of the sample identified them as Caucasian.

Discussion

This study is amongst the largest studies of women's health in autoimmunity and is of particular interest to PBC, where such issues have not been studied in detail. Of particular interest in our data was the observation that PBC is associated with an increasing number of pregnancies. This finding was validated in our multivariate analysis. This has not been noted previously in PBC and is consistent with similar data on other autoimmune diseases 11, 12. Cases also had a significantly younger

Acknowledgements

This study was supported by the National Institutes of Health: Grants DK56839 and DK39588.

References (46)

  • P.L Golding et al.

    “Sicca complex” in liver disease

    BMJ.

    (1970)
  • A.R LaBarbara et al.

    Autoimmune etiology in premature ovarian failure

    Am J Reprod Immunol.

    (1988)
  • A.J Shelton et al.

    Association between familial autoimmune diseases and recurrent spontaneous abortions

    Am J Reprod Immunol.

    (1994)
  • D.J Del Junco et al.

    The relationship between rheumatoid arthritis and reproductive function

    Br J Rheumatol.

    (1989)
  • A Engel

    Rheumatoid arthritis in US adults 1960–1962

  • C.E Dugowson et al.

    Is nulliparity a risk factor for rheumatoid arthritis?

    Arthritis Rheum.

    (1991)
  • J.M.W Hazes et al.

    Pregnancy and the risk of developing rheumatoid arthritis

    Ann Rheum Dis.

    (1990)
  • A Kay et al.

    Subfertility before and after the development of rheumatoid arthritis in women

    Ann Rheum Dis.

    (1965)
  • T.D Spector et al.

    The pill, parity, and rheumatoid arthritis

    Arthritis Rheum;

    (1990)
  • J.G Brun et al.

    Breast feeding, other reproductive factors and rheumatoid arthritis. A prospective study

    Br J Rheumatol.

    (1995)
  • M Heliovaara et al.

    Parity and the risk of rheumatoid arthritis in Finnish women

    Br J Rheumatol.

    (1995)
  • A Parikh-Patel et al.

    Risk factors for primary biliary cirrhosis in a cohort of patients from the United States

    Hepatology.

    (2000)
  • W.R Harlan et al.

    Blood pressure and nutrition in adults. The National Health and Nutrition Examination Survey

    Am J Epidemiol.

    (1984)
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