Background/Purpose: SLE can cause considerable morbidity during pregnancy. Although several studies have evaluated foetal outcome in lupus pregnancy, very few have examined the long-term outcome of children born to mothers with SLE. In a large population-based study, we aimed to determine if children born to women with SLE have an increased risk of major congenital anomalies, serious infections, and cardiac conduction disturbances compared to children born to women without SLE.

Methods: We identified all women who had ≥ 1 hospitalization for delivery after SLE diagnosis using Quebec’s physician billing and hospitalization databases (1989-2009). Women were defined as SLE cases if they had any of the following: 1) ≥ 1 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) ≥ 2 physician visits with a diagnosis of SLE, occurring 2-24 months 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 identified children born live to SLE cases and their matched controls, and ascertained major congenital anomalies (i.e. ≥ 1 hospitalization or physician visit for a major congenital anomaly < 12 months of life), serious infections (i.e. ≥ 1 hospitalization with a primary diagnosis of infection), and cardiac conduction disturbances (i.e. ≥ 1 hospitalization or 2 physician visits occurring 2-24 months apart) through to end of database follow-up.

We performed multivariate analyses to adjust for maternal demographics, sex and birth order of child, major maternal co-morbidities, obstetrical complications, and relevant maternal medication.

Results: 507 women with SLE had 721 children, while 5862 matched controls had 8561 children. Compared to controls, children born to women with SLE experienced slightly more major congenital anomalies [13.6% (95% CI 11.3, 16.3) vs 10.4% (95% CI 9.7, 11.1)], serious infections [31.5% (95% CI 28.2, 35.0) vs 26.0% (95% CI 25.1, 26.9)], and cardiac conduction disturbances [3.1% (95% CI 2.0, 4.6) vs 1.2% (95% CI 1.0, 1.4)]. Mean age at the time of serious infection was 1.8 (95% CI 1.6, 2.0) year for children born to women with SLE and 2.1 (95% CI 2.0, 2.2) years for controls, while mean age at the time of cardiac conduction disturbance was 0.2 (95% CI 0.17, 0.22) year for children born to women with SLE and 1.8 (95% CI 1.7, 1.8) year for controls.

In multivariate analyses, children born to women with SLE had substantially increased rates of serious infections (HR 1.76, 95% CI 1.21, 2.56) and cardiac conduction disturbances (HR 1.90, 95% CI 1.03, 3.52) compared to controls. There was also a trend for an increased risk of major congenital anomalies in children born to women with SLE compared to controls (OR 1.24, 95% CI 0.98, 1.58).

Conclusion: Compared to children from the general population, children born to women with SLE have increased rates of serious infections and cardiac conduction disturbances. Our findings suggest that children born to mothers with SLE might also be at slightly increased risk of major congenital anomalies and prompt further research to elucidate this issue.

---

« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-outcomes-of-children-born-to-women-with-systemic-lupus-erythematosus/