No link between ethnicity, neonatal lupus erythematosus risk
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There is no association between a child’s ethnicity and the risk for neonatal lupus erythematosus, nor for any specific disease symptoms, according to data published in The Journal of Rheumatology.
“Neonatal lupus erythematosus (NLE) is a passively acquired autoimmune disorder secondary to the transplacental passage of maternal anti-Ro,” Talia Diaz, MD, of The Hospital for Sick Children, in Toronto, and colleagues wrote. “These antibodies are present in 90% of women with Sjögren’s syndrome (SS) and in 20% to 30% of women with systemic lupus erythematosus (SLE).”
“Although the presence of maternal anti-Ro antibodies is necessary for NLE, it is not the sole risk factor causing NLE, since the majority of children born to anti-Ro antibody positive mothers are unaffected,” they added. “Previous studies have suggested that ethnicity may also influence NLE outcomes with more frequent adverse cardiac NLE outcomes reported among children of non-European ethnicity compared to children of European ethnicity. No study to date has examined the association between ethnicity and non-cardiac NLE manifestations.”
To analyze the link between ethnicity and NLE, as well as its manifestations, Diaz and colleagues conducted a cohort study of all children aged 1 year and younger, born to individuals positive for anti-Ro antibodies, and seen The Hospital for Sick Children’s NLE clinic between January 2011 and April 2019. A total of 324 children, born to 270 anti-Ro antibody positive individuals, were divided to European, non-European and mixed groups based on parent-reported ethnicity. In all, 48% of were reported as non-European, 34% were European, and 18% were mixed European and non-European.
Examined outcomes included NLE development and specific manifestations, including cardiac and cutaneous symptoms, as well as cytopenias, transaminitis and macrocephaly. In addition, the researchers compared NLE frequency between ethnic groups, using Fisher’s exact test. Links between ethnicity and NLE risk and manifestations were analyzed using logistic regression models, with covariates for the child’s sex, maternal rheumatic disease status during pregnancy, and maternal use of antimalarials during pregnancy.
According to the researchers, there was no significant association between non-European (OR = 1.14; 95% CI, 0.69-1.89) or mixed (OR = 1.06; 95% CI, 0.55-2.06) ethnicity and NLE risk, compared with European ethnicity. In addition, neither univariate nor multivariable adjusted models found any association between ethnicity and specific NLE manifestations.
“In our multiethnic population of children born to anti-Ro antibody positive mothers, we did not observe a statistically significant association between child’s ethnicity and NLE,” Diaz and colleagues wrote. “There was no difference in the odds of NLE, nor specific NLE manifestations between children of non-European, and mixed European-Non-European ancestry, compared with European ancestry, with and without accounting for child’s sex, maternal rheumatic disease status and antimalarials use during pregnancy.”
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