TOPLINE

Children born to mothers with systemic autoimmune rheumatic diseases (SARDs) had a 30% higher risk for mental disorders compared with children of mothers without these conditions, a study showed. Maternal systemic lupus erythematosus (SLE), primary Sjögren's syndrome (PSS), idiopathic inflammatory myositis (IIM), and systemic sclerosis (SSc) were each associated with increased risks for various childhood mental disorders, particularly anxiety disorders.

METHODOLOGY

• A nationwide population-based cohort study conducted in Taiwan analyzed data from the National Health Insurance Research Database and Taiwan Maternal and Child Health Database, including 3907 offspring born to mothers with SARDs and 1,946,061 offspring born to mothers without autoimmune rheumatic diseases between 2004 and 2015.
• Mothers with SARDs included those diagnosed with SLE (56.3%), rheumatoid arthritis (RA; 25.8%), PSS (14.1%), IIM (2.3%), SSc (1.7%), and systemic vasculitis (1.7%).
• The primary outcome was the diagnosis of mental disorders in the offspring, categorized according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, including neurodevelopmental disorders (NDDs) such as intellectual disability, autism spectrum disorders, attention-deficit/hyperactivity disorder (ADHD), specific learning disorders, and motor disorders, as well as other mental disorders including anxiety disorders, depressive disorders, and trauma-related disorders.
• Researchers followed offspring for a median of 11.7 years, adjusting for maternal age, maternal and paternal psychiatric history, maternal tobacco use, parity, urbanicity of residence, family income, birth sex, and cohort year. Mediation analyses assessed low birth weight and preterm birth as potential pathways linking maternal SARDs to childhood mental disorders.
• Maternal antirheumatic medication use during pregnancy was documented, with 39.5% of mothers with SARDs receiving corticosteroids, 49.2% receiving conventional disease-modifying antirheumatic drugs, and smaller proportions receiving biologic agents or immunosuppressants.

TAKEAWAY

• Offspring of mothers with SARDs had a significantly increased risk for overall mental disorders (adjusted hazard ratio [aHR], 1.30; 95% CI, 1.19-1.41).
• Among specific maternal SARDs, SSc showed the strongest association with childhood mental disorders (aHR, 1.94; 95% CI, 1.15-3.28), followed by IIM (aHR, 1.73; 95% CI, 1.06-2.83), PSS (aHR, 1.59; 95% CI, 1.29-1.97), and SLE (aHR, 1.26; 95% CI, 1.13-1.41). Maternal RA and systemic vasculitis were not significantly associated with childhood mental disorders.
• Anxiety disorders showed the highest risk among mental disorders other than NDDs (aHR, 1.55; 95% CI, 1.17-2.06). Among NDDs, motor disorders had the strongest association (aHR, 1.37; 95% CI, 1.19-1.57), followed by specific learning disorders (aHR, 1.31; 95% CI, 1.07-1.61), intellectual disability (aHR, 1.29; 95% CI, 1.12-1.49), and ADHD (aHR, 1.21; 95% CI, 1.07-1.37).
• Low birth weight mediated 18.7% of the association between maternal SARDs and childhood mental disorders (natural indirect effect, 1.05; 95% CI, 1.04-1.05). The association between maternal SARDs and childhood mental disorders was attenuated after adjusting for prenatal antirheumatic medication use (aHR, 1.10; 0.99-1.22).

IN PRACTICE

"Our findings suggest the need for monitoring MDs in offspring born to mothers with SARDs in clinical practice with multidisciplinary care," the authors wrote.

SOURCE

The study was led by Ya-Chun Huang, National Cheng Kung University Hospital, College of Medicine, Tainan City, Taiwan. It was published online on August 14 in Lupus Science & Medicine.

LIMITATIONS

The median follow-up duration may have underestimated mental disorders with peak incidence in later childhood. Data on maternal disease activity during pregnancy were unavailable, limiting assessment of the role of transplacental inflammatory cytokines and autoantibodies. Childhood mental disorders identified through claims data may have been underestimated, potentially biasing estimates toward the null. Information on potential confounders such as maternal obesity and alcohol consumption was unavailable, and maternal smoking was likely underestimated. Maternal SARDs were identified using catastrophic-illness-certificate diagnoses, which carried some misclassification risk, and mothers with overlapping SARDs were not excluded, limiting the ability to isolate disease-specific effects. Key potential confounders were not considered and unmeasured confounding from maternal genetics, lifestyle, and environmental exposures could not be ruled out.

DISCLOSURES

The study was funded by the Taiwan National Science and Technology Council, National Health Research Institutes, US National Institutes of Health, National Science and Technology Council, and Alex's Lemonade Stand Foundation. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.