Lupus in Maternity May Increase Child's Autism Risk

Children born to mothers diagnosed with systemic lupus erythematosus (SLE) may be twice as likely to develop autism as those whose mothers don’t have the chronic autoimmune disease, according to research presented at the American College of Rheumatology 2013 Annual Meeting in San Diego, CA.

For their “Increased Risk of Autism Spectrum Disorders in Children Born to Women with SLE” poster, Evelyne Vinet, MD, FRCPC, an assistant professor in the Department of Rheumatology at McGill University Health Center in Montreal, and colleagues compared 719 children born to 509 mothers with SLE — all of whom were included in the population-based Offspring of Systemic Lupus Erythematosus mothers Registry (OSLER) cohort, which lists all Canadian women who had been hospitalized for childbirth after SLE diagnosis at least once between 1989 and 2009 — to 8,493 children born to 5,824 women without the disease.

“A handful of small studies suggest an increased risk of learning disabilities in children born to women with lupus,” Vinet explained in a statement, noting that previous animal models found that autoantibodies and cytokines displayed in women with SLE have been shown to “alter fetal brain development and induce behavioral irregularities in offspring.” Despite that experimental data, Vinet said “no study has specifically assessed the risk of ASD in offspring of mothers with lupus.”

“We undertook this study because women with lupus often ask, ‘Will my disease affect the future health of my children?’ ” Vinet said. “By providing evidence to answer this relevant question, our study will help clinicians to appropriately counsel women with lupus who are planning a pregnancy.”

After performing multivariate analyses to adjust for the mothers’ demographics, the sex and birth order of the children, and obstetrical complications in delivery, Vinet and her research team discovered that children born to women with SLE had a substantially increased risk of developing ASD compared to those in the general population. In addition, the researchers found that, on average, the offspring of mothers with SLE were diagnosed with autism at 3.8 years old, which was younger than the control group’s mean age of 5.7 years old at ASD diagnosis.

To determine whether medications taken for SLE during pregnancy impacted a child’s autism diagnosis, the study authors observed a subsample of 1,925 children with maternal drug coverage. However, the researchers found that in utero medication exposures were rare among the 18 identified autism cases, as none of those children had been exposed to antimalarials, antidepressants, or immunosuppressants, and “only one case born to a SLE mother and another born to a control mother were respectively exposed to corticosteroids and anticonvulsants,” the authors wrote.

According to Vinet, the study’s findings suggest that “although the absolute risk is relatively small, when compared to children from the general population, children born to women with lupus have a two-fold increased risk of autism spectrum disorders.” In response to that substantial autism risk, Vinet and her co-authors recommended that “women with lupus who are contemplating a pregnancy should discuss with their physician to ideally plan the pregnancy at a time of low disease activity and review the safety of their medications.” The authors also called for further research on “the potential role of SLE-related autoantibodies, such as N-methyl-D-aspartate receptor antibodies, in ASD.”