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Maternal RA linked to thyroid disease, epilepsy in children
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Children born to mothers with rheumatoid arthritis have an increased risk for chronic diseases, including thyroid disease, epilepsy and rheumatoid arthritis, during childhood and adolescence, according to findings published in Arthritis Care and Research.
Line R. Jølving, MHS, of the Odense University Hospital Center for Clinical Epidemiology, in Denmark, and colleagues added that their research should encourage pediatricians and general practitioners to be more aware of chronic diseases among children who have been exposed to RA in utero.
“RA is an autoimmune disease that often aggregates in families, it affects women three times more frequently than men, and RA is one of the most common chronic diseases in pregnant women,” Jølving and colleagues wrote. “Therefore, women with RA often have concerns about a possible negative impact of their disease on the fetus when they are contemplating pregnancy. One of their main concerns may be if there is a risk of passing RA or other diseases to their offspring.”
To analyze the potential association between maternal RA and 15 selected groups of chronic diseases in children, the researchers conducted a nationwide cohort study using Danish health registries, including data on all children born alive in Denmark from Jan. 1, 1989, to Dec. 31, 2013. The study included 2,106 children born by women with RA, and 1,378,539 children born by women without RA.
The researchers used Cox proportional hazard regression models, and considered a large range of confounders, computing the HR of childhood and adolescence diseases.
Among children exposed to RA in utero, HRs were 2.19 (95% CI, 1.14–4.21) for thyroid diseases, 1.61 (95% CI, 1.16–2.25) for epilepsy and 2.89 (95% CI, 2.06–4.05) for RA, according to the researchers. The HRs for anxiety and personality disorders and chronic lung disease, including asthma, were not significant.
“The results from our study suggest that children of mothers with RA have excess morbidities during childhood and adolescence when it comes to important chronic diseases,” Jølving and colleagues wrote. “The findings in this study are relevant for pediatricians, rheumatologists and general practitioners in order to have special awareness of early symptoms of RA, thyroid disease, and epilepsy in offspring of mothers with RA.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Nicole Alexandria Smith, MD, MPH
The recent study by Jølving et al used a national database in Denmark to answer the question of whether children born to mothers with rheumatoid arthritis are at increased risk of a long list of medical problems. They did not have data on the severity of the mother’s disease, nor whether she took any medication to control her RA.
The researchers found a very small increased risk of rheumatoid arthritis, epilepsy and thyroid problems among children of mothers with RA. However, when one examines the actual risk of developing any of these diseases, it is comforting to see that the risk of RA or epilepsy among children increased from 1/100 to approximately 2/100, while the risk of thyroid problems increased from 3/1000 to 4/1000. Women with rheumatoid arthritis should be reassured that any increased risk is a very small one, and that the vast majority of children will not have these medical problems.
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