2191: Long-term Outcomes of Children Born to Mothers with Systemic Lupus Erythematosus: A Nationwide Population-based Study in Korea

In Ah Choi¹, Ji Hyoun Kim², Sung Hae Chang³, Hyun Jung Kim⁴ and Hyeong Sik Ahn⁴, ¹Chungbuk National University, Cheongju, Republic of Korea, ²Chungbuk National University Hospital, Cheongju, Republic of Korea, ³Soonchunhyang University College of Medicine, Bongmyeong-dong, Dongnam-gu, Cheonan-si, Republic of Korea, ⁴Institute for Evidence-based Medicine, Cochrane Korea, Seoul, Republic of Korea

Background/Purpose: Systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects women of childbearing age, and epidemiologic studies have shown poor maternal and fetal outcomes associated with pregnancy in patients with SLE. However, long-term outcomes of children associated with maternal SLE have not been fully described. Therefore, we are to assess the influence of maternal SLE on long-term disease outcomes of their children.

Methods: We constructed a child-mother database to track healthcare utilization using National Health Insurance Service in Korea and investigated the association between the status of maternal SLE and children's morbidities, such as autoimmune diseases [SLE, Graves' disease, Hashimoto's thyroiditis, type I diabetes, inflammatory bowel disease (IBD), juvenile rheumatoid arthritis (JRA), psoriasis, alopecia areata, and vitiligo], neurodevelopmental disorders [attention-deficit and hyperactivity disorder (ADHD), autism spectrum disease, and cerebral palsy], and allergic conditions (atopic dermatitis and asthma) up to 18 year or until the year of 2021. We categorized the status of maternal SLE as prevalent at delivery (prevalent SLE) and incident after delivery (pre-SLE). The children born to mothers unexposed to SLE were compared as control.

Results: In this large population-based cohort of children born from 2003 to 2016, we could identify 3093 children born to prevalent SLE, 3027 children born to pre-SLE and 5,063,032 controls born to mothers unexposed to SLE.

We found a higher risk of SLE development in SLE offspring compared to controls [hazard ratio (HR) 98.48, 95%CI:63.39-152.98]. The risk was higher in children born to prevalent SLE (HR 176.54, 95%CI:102.46-304.19 compared to controls), but also increased in children born to pre-SLE (HR 57.74, 95%CI:26.91-111.36 compared to controls).

The risk of other autoimmune diseases also increased in SLE offspring compared to controls (HR 1.26, 95%CI:1.02-1.57). Among them, the risk of Hashimoto's thyroiditis, IBD and JRA was significant (HR 5.31, 95%CI:2.85-9.90, HR 1.94, 95%CI:0.48-7.76 and HR 2.88, 95%CI:0.93-8.94, respectively). The increased risk compared to control was not significantly different between children born to prevalent SLE and to pre-SLE mothers.

The risk of neurodevelopmental disorders also increased in SLE offspring compared to controls (HR 1.35, 95%CI:1.15-1.57). Among them, the risk of ADHD was significant (HR 1.25, 95%CI:1.04-1.51). In case of allergic conditions, the risk was not significantly different in SLE offspring compared to controls (HR 1.02, 95%CI:0.95-1.09).

Conclusion: Our data demonstrate the negative impact of maternal SLE on long-term disease outcomes of their children in the field of SLE, other autoimmune diseases and neurodevelopmental disorders.

Disclosures: I. Choi, None; J. Kim, None; S. Chang, None; H. Kim, None; H. Ahn, None.