Background/Purpose: Growing evidence supports the role of perinatal and early life exposures in risk for chronic adult diseases. We examined perinatal and early life environmental risk factors for SLE in a national cohort of women ages 35-74 at enrollment in 2003-2009.

Methods: Questionnaire data were collected on maternal and perinatal factors and characteristics of longest childhood residence. Prevalent SLE cases (N=124; median age 54, interquartile range, IQR 47-60; diagnosis age 43, IQR 33-50) were identified based on self-reported diagnosis after age 17, and confirmed by current or past use of disease modifying anti-rheumatic drugs (DMARDs) for SLE. Non-cases were women who did not report SLE or discoid lupus (N=50,465; median age 55 years, IQR 50-61). Odds Ratios (OR) and 95% Confidence Intervals (CI) were estimated by logistic regression, adjusting for age and race/ethnicity.

Results: Most cases were non-Hispanic whites (69% vs. 84% non-cases), but cases were more likely to be African-American (19% vs. 9%; OR=2.4; 95%CI 1.5, 3.8) or Hispanic (9% vs. 5%; OR=2.2; 95%CI 1.2, 4.1). Low birth weight (<2500 grams) was associated with risk of SLE (vs. 3000-<3500 grams; OR=2.2, 95%CI 1.2, 3.9), with a significant inverse linear dose-effect for increasing birth weight based on data for 84 cases and 36,477 non-cases. Premature birth (>4 weeks vs. full-term) was also associated with SLE (OR=3.0; 95%CI 1.4, 6.5), but only 47 cases and 15,996 non-cases reported gestational age.  An association of SLE with young maternal age (<18 vs. 18-34 years) was not significant after adjusting for race/ethnicity (OR=1.7; 95%CI 0.71, 3.2), and no associations were seen for prenatal smoking exposure (maternal or household), having been breastfed, birth order, or sibling number.  SLE was associated with having a mother who worked on a farm during pregnancy (OR=1.7; 95%CI 1.1, 2.7). Considering longest childhood residence, SLE cases were more likely to have lived on a farm (OR= 1.6; 95%CI 1.0, 2.6) and reported pesticides were regularly (at least monthly) applied in and around the home (OR=2.3; 95%CI 1.3, 4.1). SLE was not associated with residential well water or childhood socioeconomic status (household education, income, food insecurity). 

Conclusion: Our observed association of premature birth with DMARD-treated SLE is consistent with other studies, but could not be separated from the effect of low birth weight. Findings on maternal farm work, childhood farm residence and household pesticide application require confirmation, but are supported by previous evidence on adult farming and pesticide exposures associated with systemic autoimmune diseases, including SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/perinatal-and-early-life-risk-factors-for-systemic-lupus-erythematosus-in-a-national-cohort-of-women/