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In utero exposure to maternal RA predisposes children to select chronic diseases

06 Feb 2018

Infants with in utero exposure to maternal rheumatoid arthritis (RA) are at an increased risk of developing thyroid disease, epilepsy and RA in childhood and adolescence, a study from Denmark suggests.

The study drew data from Danish health registries and included all children born alive from 1989‒2013, among whom 2,106 were born by women with RA (exposed) and 1,378,539 were born by women without RA (unexposed).

Cox proportional hazard regression analysis showed that the exposed group had an elevated risk of developing RA (hazard ratio [HR], 2.89; 95 percent CI, 2.06–4.05), thyroid diseases (HR, 2.19; 1.14–4.21) and epilepsy (HR, 1.61; 1.16–2.25) compared with the unexposed group. The HRs for anxiety, personality disorders and chronic lung diseases, including asthma, were in the range of 1.15–1.16, although they were not statistically significant.

“Our results call for special attention on child development of RA, thyroid disease and epilepsy if exposed to RA in utero,” researchers said. “These … should encourage paediatricians and general practitioners to an increased awareness of certain chronic diseases in children being exposed to RA in utero.”

Although the study was not able to determine the biologic mechanisms (ie, the role or contribution of genetic factors and factors related to the intrauterine environment) underlying the association of in utero exposure with maternal RA and risk of specific chronic diseases, researchers speculated that genetic factors might explain the excess morbidity when it comes to RA in the offspring.

“However, the results might also partly be due to factors related to an impact of maternal RA itself on the foetal environment, for instance, an impact due to disease activity or medical treatment,” they said.

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