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Systemic lupus erythematosus during pregnancy is not associated with school performance in offspring - A Danish
Signe S Knudsen1,2,3, Julia F Simard2, Jakob S Knudsen4
1Department of Public Health, Aarhus University, Aarhus, Denmark.
Insights
Children born to mothers with Systemic Lupus Erythematosus (SLE) show no difference in school test performance. In utero exposure to SLE, hydroxychloroquine, or immunosuppressants did not harm neurocognitive development.
Area of Science:
- Obstetrics and Gynecology
- Pediatrics
- Rheumatology
Background:
- Systemic Lupus Erythematosus (SLE) in pregnancy is linked to adverse offspring outcomes, including neurodevelopmental disorders.
- Long-term cognitive development in children of mothers with SLE is not well-studied.
Purpose of the Study:
- To compare the long-term cognitive development of children born to mothers with SLE versus the general population.
- To investigate the impact of in utero exposure to SLE and related medications on child neurocognition.
Main Methods:
- Utilized Danish National School Test data (grades 2-8) for reading and mathematics.
- Included 738,862 children born in Denmark (1995-2008), identifying 312 born to mothers with SLE.
- Analyzed medication exposures (hydroxychloroquine, immunosuppressants) during pregnancy.
Main Results:
- No significant differences in reading or mathematics test scores were found between children of mothers with and without SLE.
- A non-significant trend towards lower scores was observed in children exposed to hydroxychloroquine/immunosuppressants, but not in those exposed for non-SLE reasons.
Conclusions:
- In utero exposure to SLE, hydroxychloroquine, and/or immunosuppressants does not appear to cause major harm to neurocognitive development as measured by school performance.
- This study suggests a favorable long-term cognitive outlook for children born to mothers with SLE.
Introduction:
Systemic lupus erythematosus (SLE) in pregnancy is considered a risk factor for a range of adverse outcomes in the offspring. Studies have indicated increased risk of neurodevelopmental disorders such as autism spectrum disorders, dyslexia and ADHD. However, the overall long-term cognitive development of children born to women with SLE has scarcely been examined. In this study, we compare test scores from the Danish National School Tests of children born to women SLE with children of the background population.
Methods:
We included all singleton children born in Denmark between 1995 and 2008, who were listed in the Danish National School Test Register (n=738,862). Children born to women with SLE were identified through linkage of national healthcare registers. We assessed the children's performance in the national school tests between 2nd and 8th grade, in reading and mathematics. Information on the mothers' redeemed prescriptions in pregnancy was included in stratified analyses. Differences of mean test scores were derived from linear regressions and compared according to maternal SLE status, and predefined categories of medication exposures.
Results:
In total, 312 (0.04%) children were born to mothers with SLE. There were no differences in performance in neither reading nor mathematics tests between those born to mothers with SLE and children born to mothers without SLE. When stratifying on medication exposures among children whose mothers had SLE, there was a non-significant tendency towards poorer results among those exposed to hydroxychloroquine and/or immunosuppressants (n=31), compared to those not exposed to these medications. A similar tendency was not observed among children whose mothers received hydroxychloroquine for non-SLE reasons (n=1,235).
Conclusion:
This study indicates no major harmful effect on the child's neurocognitive development from exposure in utero to SLE, hydroxychloroquine and/or immunosuppressants, as measured by school performance.
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