Maternal systemic autoimmune rheumatic diseases and childhood mental disorders: a nationwide cohort study

Prior studies suggested that maternal systemic autoimmune rheumatic diseases (SARDs) may increase the risk of mental disorders (MDs) in offspring. However, evidence is limited by heterogeneous definitions of autoimmune rheumatic diseases, focusing on specific MDs and scarce data from Asian populations. We aimed to investigate the association between maternal SARDs and the risk of childhood MDs.

Our study included 1 949 968 maternal-child dyads identified in the Taiwan Maternal and Child Health Database between 2004 and 2015. Maternal SARD diagnoses were identified based on approved catastrophic illness certificates, while childhood MDs were identified by documentation of a relevant diagnostic code in the nationwide health insurance claims data. Cox proportional hazard models were used to examine the association between maternal SARDs and childhood MDs.

After a mean follow-up of 11.7 years, there were 774 (19.8%) and 306 907 (15.8%) live births born to mothers with and without SARDs respectively, which developed childhood MDs. Maternal SARDs were associated with an increased risk of childhood MDs (HR, 1.30; 95% CI 1.19 to 1.41). Elevated risks of childhood MDs were observed among offspring of mothers with systemic lupus erythematosus (HR=1.26, 95% CI 1.13 to 1.41), primary Sjogren's syndrome (HR=1.59, 95% CI 1.29 to 1.97), idiopathic inflammatory myositis (HR=1.73, 95% CI 1.06 to 2.83) and systemic sclerosis (HR=1.94, 95% CI 1.15 to 3.28), compared with mothers without SARDs.

In this nationwide, population-based study from an Asian population, maternal SARDs were associated with higher risks of childhood MDs. Our findings suggest early monitoring of MDs among offspring of mothers with SARDs as part of clinical practice.