Children born to women with rheumatoid arthritis (RA) have an increased risk for thyroid disease, epilepsy, and RA compared with children born to mothers who do not have RA, according to data from a nationwide cohort study conducted in Denmark.
These findings suggest that pediatricians and primary care physicians should maintain “an increased awareness of certain chronic diseases in children being exposed to RA in utero,” the authors write. Specifically, the results “call for special attention on child development of rheumatoid arthritis, thyroid disease, and epilepsy if exposed to rheumatoid arthritis in utero.”
Line Jølving, MHS, from Odense University Hospital, Denmark, and colleagues published their findings online December 11 in Arthritis Care & Research.
The effect of maternal RA on the fetus is a major concern among women with this condition when they consider pregnancy, but information on the subject is scarce, the researchers explain. The researchers compared the incidence of specific chronic diseases in children born to mothers with and without RA from January 1, 1989, through December 31, 2013, with follow-up lasting until December 31, 2014.
They used data from several national registries, which together included all live births occurring in Denmark within the study period. For each woman with RA, the authors confirmed the diagnosis by examining her medical records for 10 years before the birth of her child. The children were followed until they died, until they were diagnosed with a significant health condition, or until the end of the follow-up period.
The study included 1,380,645 children. Of those, 2106 were born to 1504 women diagnosed with RA during the previous 10 years and were placed in the “exposed” cohort. The remaining 1,378,539 children comprised the “unexposed” cohort. Overall, the children were followed for a median of 13.7 years.
Compared with women who did not have RA, mothers with RA were older at the time of delivery (58.6% vs 46.9% were 30 – 39 years of age; 4.3% vs 2.3% were >40 years of age). Children in the exposed cohort were more likely to be born by cesarean delivery (28.2% vs 15.0% of children in the unexposed cohort), to be born prematurely (10.1% vs 6.2%), and to be small for gestational age (5.1% vs 3.8%).
After adjustment for potential confounders, including mode of delivery and maternal age at birth, smoking status, and prepregnancy body mass index, children in the exposed group had an adjusted hazard ratio (HR) for RA of 2.89 (95% confidence interval [CI], 2.06 – 4.05) compared with children in the unexposed cohort, the authors write. The exposed children also had an increased risk for thyroid disease, with an adjusted HR of 2.19 (95% CI, 1.14 – 4.21), and of epilepsy, with an adjusted HR of 1.61 (95% CI, 1.16 – 2.25).
The risk for chronic lung disease (including asthma) and anxiety and personality disorders also was higher among children in the exposed cohort; however, these differences did not attain statistical significance, the authors add.
This study includes the largest number of children born by mothers with a prenatal diagnosis of RA and supports earlier findings by other investigators that also showed an association between maternal RA and chronic diseases in their children, they write. These results are strengthened by the fact that they are “based on a high number of exposed children, and data derives from registers appropriate for research, with a reported high validity.”
Study limitations include the possibility that some of the children may have been misdiagnosed, a lack of access to socioeconomic data on the families, a lack of outcome data from patients of general practitioners, and limited length of follow-up time.
These findings suggest that “children of mothers with RA have excess morbidities during childhood and adolescence when it comes to important chronic diseases,” the authors conclude, adding “future studies focusing on the underlying biological mechanisms are warranted.”
The authors have disclosed no relevant financial relationships.
Arthritis Care Res. Published online December 11, 2017. Abstract
For more news, join us on Facebook and Twitter
Tidak ada komentar:
Posting Komentar