Prenatal exposure to maternal autoimmune diseases associated with increased risks of mental disorders in offspring

1. In utero exposure to any maternal autoimmune disease was associated with increased risks of overall and type-specific mental disorders in offspring.

2. Maternal type 1 diabetes and rheumatoid arthritis during pregnancy were associated with offspring’s mental health up to early adulthood.

Evidence Rating Level: 2 (Good)

Study Rundown: Previous population-based studies have demonstrated the association between maternal autoimmune disease during pregnancy and increased risks for specific mental disorders in offspring during childhood. However, there is limited longitudinal research on its effects on overall mental health after childhood and in early adulthood. This Danish registry-based cohort study evaluated the associations between any maternal autoimmune disease diagnosed before childbirth and the risk of mental disorders in offspring up to early adulthood. The main outcome was the full spectrum of mental disorders in offspring. In this large Danish population-based cohort study, prenatal exposure to maternal autoimmune diseases was associated with increased risks of mental disorders in offspring. Maternal type 1 diabetes and rheumatoid arthritis during pregnancy were associated with overall mental disorders in offspring up to early adulthood. These findings suggest that a wide range of mental disorders should be monitored in offspring with prenatal exposure to maternal autoimmune diseases, where exposed individuals may benefit from long-term mental health surveillance. A limitation of this study was that despite a follow-up period of up to 38 years, the study was not able to investigate the risks of mental disorders in late adulthood.

Click to read the study in JAMA Network Open

Relevant Reading: Parental autoimmune diseases associated with autism spectrum disorders in offspring

In-Depth [prospective cohort]: This population-based nationwide cohort study included 2 254 234 singleton infants (median [IQR] age, 16.7 [10.5-21.7] years; 51.28% male) born in Denmark between 1978-2015 with up to 38 years of follow-up. According to the Danish National Patient Register, 2.26% of participants were exposed to maternal autoimmune disease during pregnancy, where there was an increased risk of overall mental disorders compared with unexposed individuals (HR, 1.16; 95%CI, 1.13-1.19; incidence, 9.38 vs 7.91 per 1000 person-years). Specifically, increased risk associated with any maternal autoimmune disorder was observed for organic disorders (HR, 1.54; 95%CI, 1.21-1.94), schizophrenia (HR, 1.35; 95%CI, 1.21-1.51), obsessive compulsive disorder (HR, 1.42; 95%CI, 1.24-1.63), mood disorders (HR, 1.12; 95%CI, 1.04-1.21), and a series of neurodevelopmental disorders (childhood autism [HR, 1.21; 95%CI, 1.08-1.36] and attention-deficit/hyperactivity disorder [HR, 1.19; 95%CI, 1.12-1.26]). Maternal type 1 diabetes (1-5 years: HR, 1.35 [95%CI, 1.17-1.57]; 6-18 years: HR, 1.24 [95%CI, 1.15-1.33]; >18 years: HR, 1.19 [95%CI, 1.09-1.30]) and rheumatoid arthritis (1-5 years: HR, 1.42 [95%CI, 1.16 1.74]; 6-18 years: HR, 1.19 [95%CI, 1.05-1.36]; >18 years: HR, 1.28 [95%CI, 1.02-1.60]) during pregnancy were associated with increased risks of mental disorders in offspring up to early adulthood.

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