Increased Male-to-Female Ratio in Children Born to Women with Systemic Lupus Erythematosus

Evelyne Vinet¹, Sasha Bernatsky², Mohammed Kaouache², Emil P. Nashi³, Christian A. Pineau³, Ann E. Clarke⁴, Robert W. Platt⁵, Meggan C. Mackay⁶ and Cynthia Aranow⁷, ¹McGill University Health Centre, Montreal, QC, Canada, ²Clinical Epidemiology, Research Institute of the McGill University Health Ctre, Montreal, QC, Canada, ³Rheumatology, McGill University Health Centre, Montreal, QC, Canada, ⁴Division of Rheumatology, University of Calgary, Alberta, Calgary, AB, Canada, ⁵McGill University, Montreal, QC, Canada, ⁶Autoimmune & Musculoskeletal Disease, The Feinstein Institute, Manhasset, NY, ⁷Feinstein Institute for Medical Research, Manhasset, NY

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: pregnancy and systemic lupus erythematosus (SLE)

Session Information

Title: Systemic Lupus Erythematosus: Clinical Aspects

Session Type: Abstract Submissions (ACR)

Background/Purpose: Recent experimental evidence suggests that anti-DNA antibodies, cross-reacting with brainstem neuronal receptors, induce apoptosis and cause a marked preferential loss of female foetuses in SLE murine models. Observational studies assessing the sex of offspring born to women with SLE are scant and limited by their sample size. In a large population-based study, we aimed to determine the sex ratio of children born to women with SLE and to compare with children born to women without SLE.

Methods: We identified all women who had at least one hospitalization for a delivery (either for a stillbirth or live birth) after SLE diagnosis using Quebec’s physician billing and hospitalization databases (from 01/01/1989 to 31/12/2009). Women were defined as SLE cases if they had any of the following: 1) at least one hospitalization with a diagnosis of SLE prior to the delivery, 2) a diagnosis of SLE recorded at the time of their hospitalization for delivery, or 3) at least 2 physician visits with a diagnosis of SLE, occurring 2 months to 2 years apart, prior to the delivery. We randomly selected a general population control group, composed of women matched at least 4:1 for age and year of delivery, who did not have a diagnosis of SLE prior to or at the time of delivery. We obtained information on sex for all births occurring in both groups of women, and calculated the respective male-to-female ratio. We performed a multivariate logistic regression, with the offspring’s sex as the dependent variable, adjusting for the potential effect of preeclampsia (previously shown to increase the male-to-female ratio in the general population).

Results: 507 women with SLE had a total of 731 births after diagnosis, while 5862 matched control women had 8631 births. The prevalence of preeclampsia was 5.5% (95% CI 4.0, 7.6) in children born to women with SLE and 2.2% (95% CI 1.9, 2.5) in children born to control women. The unadjusted male-to-female ratio was increased in children born to women with SLE (1.26, 95% CI 1.09,1.46) compared with controls (1.06, 95% CI 1.02,1.11). In multivariate analysis adjusting for the effect of preeclampsia, mothers with SLE had substantially increased odds of having male offspring than mothers without SLE (OR 1.19, 95% CI 1.02, 1.38).

Conclusion: Compared to children from the general population, there is a substantial increase in the male-to-female ratio in children born to women with SLE. These results should prompt further research on the male predominance in children born to women with SLE.

Disclosure:

E. Vinet,
None;

S. Bernatsky,
None;

M. Kaouache,
None;

E. P. Nashi,
None;

C. A. Pineau,
None;

A. E. Clarke,
None;

R. W. Platt,
None;

M. C. Mackay,
None;

C. Aranow,
None.

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