Maternal autoimmune disease and offspring mental disorder

Maternal autoimmune disease and offspring mental disorder | Image Credit: © Subbotina Anna - © Subbotina Anna - stock.adobe.com.

Prenatal exposure to maternal autoimmune diseases is associated with increased mental disorder risk in offspring, according to a recent study published in JAMA Network Open.

Autoimmune diseases are reported in over 5% of individuals and are associated with significant burdens. Female individuals in childbearing years are at an increased risk of autoimmune disease, with animal studies indicating offspring neurologic features may be altered by maternal immune activation.

Most prior studies on the link between maternal autoimmune disease and offspring mentaldisorders focused on specific diseases. To determine how a general range of maternal autoimmune disorders impact offspring risk for the full spectrum of mental disorders, investigators conducted a cohort study from March 1, 2020, to September 30, 2021.

The study population consisted of 2,254,234 singleton live births in Danish national registers from 1978 to 2015. Prenatal exposure to maternal autoimmune disease was determined through maternal autoimmune disease diagnosis before childbirth. The Danish National Patient Register (NPR) was used to gather autoimmune disease information.

Data was gathered on 29 different maternal autoimmune diseases, classified using International Classification of Diseases, Eighth Revision (ICD-8) codes for 1969 to 1993 and ICD-10 codes for 1994 onward. The first day of hospital contact was used to determine the time of onset, with the earliest autoimmune disease used in mothers with multiple autoimmune diseases.

The Psychiatric Central Research Register and the NPR were consulted for data on mental disorders, which were classified using ICD-8 and ICD-10 codes. Offspring with multiple mental disorders were included in the calculations for each disorder separately.

Covariates included sex of child, calendar period of birth, parental psychiatric history before childbirth, maternal parity, maternal age at birth, maternal education level, maternal country of birth, and cohabitation with a partner.

Of infants, 51.28% were male and 2.26% born to mothers with an autoimmune disease diagnosis before or during pregnancy. Follow-up lasted for 38 years, during which a mental disorder was diagnosed in 10.73% of offspring exposed to maternal autoimmune disease and 13.76% of offspring not exposed.

Exposed offspring had an incidence rate of any mental disorder of 9.38 per 1000 person-years compared to non-exposed offspring with an incidence rate of 7.91 per 1000 person-years. The risk of developing a mental disorder was 16% higher in exposed offspring compared to non-exposed offspring.

Primary biliary cirrhosis had the highest associated risk of offspring mental disorders, followed by type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, and psoriasis vulgaris. Associations were found in all age groups.

The most common mental disorders observed were organic disorders, obsessive-compulsive disorder, schizophrenia, and mood disorders. However, increased risks of intellectual disability, attention-deficit/hyperactivity disorder, and childhood autism were also observed.

These results indicate increased risks of mental disorders in offspring with prenatal exposure to maternal autoimmune disease. Investigators recommended long-term surveillance of mental disorders in offspring exposed to autoimmune diseases.

Reference

He H, Yu Y, Liew Z, et al. Association of maternal autoimmune diseases with risk of mental disorders in offspring in Denmark. JAMA Netw Open. 2022;5(4):e227503. doi:10.1001/jamanetworkopen.2022.7503