Increased risk of autism spectrum disorders in children born to women with systemic lupus erythematosus: Results from a large population-based cohort

Évelyne Vinet, Christian A. Pineau, Ann E. Clarke, Susan Scott, Eric Fombonne, Lawrence Joseph, Robert W. Platt, Sasha Bernatsky

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objective In utero exposure to maternal antibodies and cytokines are potential risk factors for autism spectrum disorders (ASDs). The aim of this study was to determine whether children born to mothers with systemic lupus erythematosus (SLE) have an increased risk of ASD compared to children born to mothers without SLE. Methods The study population was derived from the Offspring of SLE Mothers Registry (OSLER), a large population-based cohort identified through healthcare databases in Quebec (1989-2009) comprising all women who had ≥1 hospitalization for a delivery (stillbirth or live birth) after SLE diagnosis. As general population controls, a randomly selected group of women without SLE was matched ≥4:1 to the mothers with SLE for age and year of delivery. Children born live to mothers with SLE and those born live to matched controls were identified, and a recorded diagnosis of ASD was ascertained for each child. Multivariate analyses were performed to adjust for parents' demographic characteristics, sex, birth order of the child, maternal comorbidities, and obstetric complications. Results In total, 509 women with SLE had 719 children, and 5,824 matched controls had 8,493 children. Children born to women with SLE were more frequently found to have a diagnosis of ASD compared to controls (frequency of recorded ASDs 1.4% [95% confidence interval (95% CI) 0.8-2.5] versus 0.6% [95% CI 0.5-0.8]), a difference of 0.8% (95% CI 0.1-1.9). The mean age at ASD diagnosis was younger in offspring of SLE mothers (mean 3.8 years, 95% CI 1.8-5.8) compared to offspring of controls (mean 5.7 years, 95% CI 4.9-6.5). In primary multivariate analysis, SLE offspring had a substantially increased risk of ASD compared to controls (odds ratio 2.19, 95% CI 1.09-4.39). Conclusion Compared to children from the general population, children born to women with SLE have an increased risk of ASD, although, in absolute terms, it represents a rare outcome. These hypothesis-generating data provide direction for additional studies of maternal autoimmunity and ASD risk.

Original languageEnglish (US)
Pages (from-to)3201-3208
Number of pages8
JournalArthritis and Rheumatology
Volume67
Issue number12
DOIs
StatePublished - Dec 1 2015

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Systemic Lupus Erythematosus
Mothers
Population
Confidence Intervals
Autism Spectrum Disorder
Multivariate Analysis
Maternal Exposure
Birth Order
Population Control
Stillbirth
Quebec
Live Birth
Autoimmunity
Sex Characteristics
Obstetrics
Registries
Comorbidity
Hospitalization
Parents
Odds Ratio

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy
  • Rheumatology

Cite this

Increased risk of autism spectrum disorders in children born to women with systemic lupus erythematosus : Results from a large population-based cohort. / Vinet, Évelyne; Pineau, Christian A.; Clarke, Ann E.; Scott, Susan; Fombonne, Eric; Joseph, Lawrence; Platt, Robert W.; Bernatsky, Sasha.

In: Arthritis and Rheumatology, Vol. 67, No. 12, 01.12.2015, p. 3201-3208.

Research output: Contribution to journalArticle

Vinet, Évelyne ; Pineau, Christian A. ; Clarke, Ann E. ; Scott, Susan ; Fombonne, Eric ; Joseph, Lawrence ; Platt, Robert W. ; Bernatsky, Sasha. / Increased risk of autism spectrum disorders in children born to women with systemic lupus erythematosus : Results from a large population-based cohort. In: Arthritis and Rheumatology. 2015 ; Vol. 67, No. 12. pp. 3201-3208.
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abstract = "Objective In utero exposure to maternal antibodies and cytokines are potential risk factors for autism spectrum disorders (ASDs). The aim of this study was to determine whether children born to mothers with systemic lupus erythematosus (SLE) have an increased risk of ASD compared to children born to mothers without SLE. Methods The study population was derived from the Offspring of SLE Mothers Registry (OSLER), a large population-based cohort identified through healthcare databases in Quebec (1989-2009) comprising all women who had ≥1 hospitalization for a delivery (stillbirth or live birth) after SLE diagnosis. As general population controls, a randomly selected group of women without SLE was matched ≥4:1 to the mothers with SLE for age and year of delivery. Children born live to mothers with SLE and those born live to matched controls were identified, and a recorded diagnosis of ASD was ascertained for each child. Multivariate analyses were performed to adjust for parents' demographic characteristics, sex, birth order of the child, maternal comorbidities, and obstetric complications. Results In total, 509 women with SLE had 719 children, and 5,824 matched controls had 8,493 children. Children born to women with SLE were more frequently found to have a diagnosis of ASD compared to controls (frequency of recorded ASDs 1.4{\%} [95{\%} confidence interval (95{\%} CI) 0.8-2.5] versus 0.6{\%} [95{\%} CI 0.5-0.8]), a difference of 0.8{\%} (95{\%} CI 0.1-1.9). The mean age at ASD diagnosis was younger in offspring of SLE mothers (mean 3.8 years, 95{\%} CI 1.8-5.8) compared to offspring of controls (mean 5.7 years, 95{\%} CI 4.9-6.5). In primary multivariate analysis, SLE offspring had a substantially increased risk of ASD compared to controls (odds ratio 2.19, 95{\%} CI 1.09-4.39). Conclusion Compared to children from the general population, children born to women with SLE have an increased risk of ASD, although, in absolute terms, it represents a rare outcome. These hypothesis-generating data provide direction for additional studies of maternal autoimmunity and ASD risk.",
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T1 - Increased risk of autism spectrum disorders in children born to women with systemic lupus erythematosus

T2 - Results from a large population-based cohort

AU - Vinet, Évelyne

AU - Pineau, Christian A.

AU - Clarke, Ann E.

AU - Scott, Susan

AU - Fombonne, Eric

AU - Joseph, Lawrence

AU - Platt, Robert W.

AU - Bernatsky, Sasha

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N2 - Objective In utero exposure to maternal antibodies and cytokines are potential risk factors for autism spectrum disorders (ASDs). The aim of this study was to determine whether children born to mothers with systemic lupus erythematosus (SLE) have an increased risk of ASD compared to children born to mothers without SLE. Methods The study population was derived from the Offspring of SLE Mothers Registry (OSLER), a large population-based cohort identified through healthcare databases in Quebec (1989-2009) comprising all women who had ≥1 hospitalization for a delivery (stillbirth or live birth) after SLE diagnosis. As general population controls, a randomly selected group of women without SLE was matched ≥4:1 to the mothers with SLE for age and year of delivery. Children born live to mothers with SLE and those born live to matched controls were identified, and a recorded diagnosis of ASD was ascertained for each child. Multivariate analyses were performed to adjust for parents' demographic characteristics, sex, birth order of the child, maternal comorbidities, and obstetric complications. Results In total, 509 women with SLE had 719 children, and 5,824 matched controls had 8,493 children. Children born to women with SLE were more frequently found to have a diagnosis of ASD compared to controls (frequency of recorded ASDs 1.4% [95% confidence interval (95% CI) 0.8-2.5] versus 0.6% [95% CI 0.5-0.8]), a difference of 0.8% (95% CI 0.1-1.9). The mean age at ASD diagnosis was younger in offspring of SLE mothers (mean 3.8 years, 95% CI 1.8-5.8) compared to offspring of controls (mean 5.7 years, 95% CI 4.9-6.5). In primary multivariate analysis, SLE offspring had a substantially increased risk of ASD compared to controls (odds ratio 2.19, 95% CI 1.09-4.39). Conclusion Compared to children from the general population, children born to women with SLE have an increased risk of ASD, although, in absolute terms, it represents a rare outcome. These hypothesis-generating data provide direction for additional studies of maternal autoimmunity and ASD risk.

AB - Objective In utero exposure to maternal antibodies and cytokines are potential risk factors for autism spectrum disorders (ASDs). The aim of this study was to determine whether children born to mothers with systemic lupus erythematosus (SLE) have an increased risk of ASD compared to children born to mothers without SLE. Methods The study population was derived from the Offspring of SLE Mothers Registry (OSLER), a large population-based cohort identified through healthcare databases in Quebec (1989-2009) comprising all women who had ≥1 hospitalization for a delivery (stillbirth or live birth) after SLE diagnosis. As general population controls, a randomly selected group of women without SLE was matched ≥4:1 to the mothers with SLE for age and year of delivery. Children born live to mothers with SLE and those born live to matched controls were identified, and a recorded diagnosis of ASD was ascertained for each child. Multivariate analyses were performed to adjust for parents' demographic characteristics, sex, birth order of the child, maternal comorbidities, and obstetric complications. Results In total, 509 women with SLE had 719 children, and 5,824 matched controls had 8,493 children. Children born to women with SLE were more frequently found to have a diagnosis of ASD compared to controls (frequency of recorded ASDs 1.4% [95% confidence interval (95% CI) 0.8-2.5] versus 0.6% [95% CI 0.5-0.8]), a difference of 0.8% (95% CI 0.1-1.9). The mean age at ASD diagnosis was younger in offspring of SLE mothers (mean 3.8 years, 95% CI 1.8-5.8) compared to offspring of controls (mean 5.7 years, 95% CI 4.9-6.5). In primary multivariate analysis, SLE offspring had a substantially increased risk of ASD compared to controls (odds ratio 2.19, 95% CI 1.09-4.39). Conclusion Compared to children from the general population, children born to women with SLE have an increased risk of ASD, although, in absolute terms, it represents a rare outcome. These hypothesis-generating data provide direction for additional studies of maternal autoimmunity and ASD risk.

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