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The development of offspring from mothers with systemic lupus erythematosus. A systematic review
Fjodor A Yousef Yengej1, Annet van Royen-Kerkhof2, Ronald H W M Derksen1
1Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Maternal systemic lupus erythematosus (SLE) is linked to learning disorders, autism spectrum disorders (ASD), and attention deficits in children. Further research is needed to confirm these findings and explore other developmental areas.
Area of Science:
- Pediatric Development
- Autoimmune Diseases
- Neurodevelopmental Disorders
Background:
- Maternal autoimmune diseases, such as systemic lupus erythematosus (SLE), may impact fetal development.
- Understanding the specific risks associated with maternal SLE is crucial for early intervention and management.
Purpose of the Study:
- To systematically review and analyze existing data on the influence of maternal SLE on various aspects of child development.
- To identify specific developmental outcomes associated with maternal SLE and evaluate the strength of evidence.
Main Methods:
- A systematic literature review was performed using PubMed and Embase databases.
- Studies investigating the association between maternal SLE or related antibodies and child physical, neurocognitive, psychiatric, or motor development were included.
- Data from 24 cohort and 4 case-control studies were analyzed.
Main Results:
- Learning disorders (LD) were observed in 21.4-26% of offspring, higher than the general population.
- Increased rates of dyslexia, autism spectrum disorders (ASD), and speech disorders were reported in children of mothers with SLE.
- While IQ and motor skills were generally unaffected, attention and behavioral disorders showed mixed results. Maternal anti-SSA antibodies were linked to LD in one study.
Conclusions:
- Maternal SLE is associated with an increased risk of LD, ASD, attention deficit, and potentially speech problems in offspring.
- The current evidence level for many findings is low to moderate, necessitating further rigorous research.
- Future studies should also investigate less-explored areas like cardiopulmonary functioning in children exposed to maternal SLE.
Objective:
To analyze published data on the influence of maternal systemic lupus erythematosus (SLE) on different aspects of child development.
Methods:
A systematic review was conducted using PubMed and Embase searches for SLE or SLE-related antibodies and physical, neurocognitive, psychiatric or motor development outcomes in children.
Results:
In total 24 cohort and 4 case-control studies were included after initial screening of 1853 hits. Learning disorders (LD) were reported in 21.4-26% of SLE offspring, exceeding the prevalence in the general population. Four studies reported that dyslexia and reading problems were present in 14.3-21.6% of lupus offspring with a clear male predominance. Furthermore, a twofold increased rate of autism spectrum disorders (ASD) (n=1 study) and a two- to threefold increased risk for speech disorders (n=3 studies) were reported in lupus offspring compared to controls, although the latter was not statistically significant. More divergent results were found for attention deficit (n=5 studies) and behavior disorders (n=3 studies). In two large controlled studies attention disorders were more prevalent and a trend towards more behavior disorders was reported in 2 of 3 studies analyzing this subject. Finally, IQ and motor skills were not affected in respectively 7 and 5 studies. Cardiopulmonary functioning and mood disorders were scarcely investigated (both n=1). Maternal anti-SSA antibodies were associated with LD in offspring in one study. Other SLE-related antibodies were rarely studied.
Conclusion:
This systematic review suggests that maternal SLE is associated with LD (specifically dyslexia), ASD, attention deficit and probably speech problems in offspring. However, over half of the studies were assigned a low or moderate evidence level. Therefore, further research is necessary to substantiate the found evidence and expand the scope to lesser researched areas such as cardiopulmonary functioning.
