FRI0291 Long term outcomes of children born to mothers with sle: predictors of child development and infections

Abstract

Background Certain immunosuppressive agents are used in pregnancy in SLE patients to prevent flare and ensure optimal outcome for mother and child. There is little literature regarding long term outcomes of children.US data suggested a link between azathioprine(AZA) and infection1, and between anticardiolipin antibodies(abs) and developmental delay2 have been suggested. Objectives To assess if potential risk factors including maternal disease, autoantibodies, immunosuppression or other medication exposure influence health and behaviour of children. The following will be addressed:1)Does exposure to AZA in pregnancy &/or lactation increase risk of serious infections defined as requiring hospital assessment in the exposed children 2)Do immunosuppressive drugs or anti-phospholipid abs increase risk of developmental problems (delay±special needs±attention deficit disorder(ADD)±special educational needs). Methods A cross sectional, retrospective study recruited women with 4 SLE ACR criteria attending 8 specialist UK clinics with pregnancy data for children under 17yrs born after maternal SLE diagnosis. A standard questionnaire developed for this multi-centre study and used in US was used to collect data. Potential factors influencing infection and developmental problems, assessed were AZA, prednisolone, hydroxychloroquine, aspirin or heparin use in pregnancy, antiphospholipid syndrome, lupus anticoagulant &/or anticardiolipin (IgG&/orIgM) abs. Potential confounders assessed were pregnancy duration, pre-eclampsia, intra-uterine growth restriction, low birth weight, child age at assessment, maternal age at delivery, disease duration, prior renal biopsy and smoking. Results Complete data was available for 288 children born alive to 200 women: 66% Caucasian, 15% South Asian, 10% Afro-Caribbean,1% Chinese, 1% Hispanic 4% other and 4% not stated. The median (range) age of women at delivery was 32 (19-44) yrs, and duration of maternal disease was 6 (0-27) yrs. Infections were reported in 45(16%) of children. The odds ratio (OR) for infection in children with exposure to AZA was 1.63 (95%CI 0.84-3.15, p=0.15). In total 14(4%) of children were reported to have developmental delays, 7(2.5%) special needs, 3(1%) ADD and 6(2%) special educational needs. OR for developmental problems with AZA exposure was 1.22, 95%CI 0.44-3.42, and if mothers had antiphospholipid abs was 0.73, 95%CI 0.22-2.35. The age of child at assessment was associated with a small increased risk of developmental problems OR 1.15, 95%CI 1.05-1.26, p=0.003. No other potential risk factors were associated with infections or developmental problems. Conclusions No risk factors were identified for infection requiring hospital assessment, and only age of child at assessment was associated with increased risk of developmental problems. This study provides data to counsel women with SLE. References Akhtaret al. Maternal Anticardiolipin Affects Childhood Development.A&R.2008.57:9,443 Marderet al. In utero AZA exposure and increased utilization of special education...

Prevention and treatment of neonatal lupus – a literature review

“…It has been established that the risk of giving birth to a sick child is increased in HLA-B8 and HLA-DR3 mothers (22) , and mothers with homozygous deficiency of complement C4 (23) . It is likely that sex hormones also play a role: the ratio of affected girls to affected boys is 2:1, which is related to the effect of oestradiol on the potential activation of T and NK cells (1) . Interestingly, the risk of giving birth to a second child with CHB by a sick mother increases 6-to 10-fold, even if the first child presented only with skin symptoms associated with maternal anti-Ro(SSA) and La(SSB) Abs (24,25) .…”

“…NL most commonly manifests as skin lesions and cardiac conduction abnormalities. The incidence rate of NL is estimated at about 1 in 15,000 to 20,000 live births, and is higher among Caucasians (1) . Early diagnosis and, above all, prevention of NL are closely associated with improvements in the quality of medical care and pregnancy planning for women with autoimmune disorders.…”