POS0569 LONG-TERM OUTCOMES OF CHILDREN BORN TO WOMEN WITH RHEUMATOID ARTHRITIS
Authors: Calin N. , Florescu A. T. , Bobirca F. , Tataru C. , Ancuta I. , Bojinca M. , Mihai C. , Balanescu A. , Musetescu A. , Micu M. , Ancuta C. , Stoica V. , Andreoli L. , Anca B. 
Published: May 2021

Background:

Children born to women with rheumatoid arthritis (RA) have increased incidences of adverse neonatal outcomes and a potential excess risk of specific diseases during childhood and adolescence [1]. Further studies aimed at confirming long-term consequences in the offspring are needed.

Objectives:

To evaluate whether maternal RA has an impact on the health and developmental outcomes of the offspring.

Methods:

A retrospective descriptive study was conducted on data regarding 43 children born to mothers diagnosed with either RA or juvenile idiopathic arthritis (JIA) prior to conception. Participants were recruited from several Clinics of Rheumatology located across Romania. Data on neonatal outcomes, lactation, developmental milestones, childhood illnesses, and hospitalizations was collected using a patient-reported questionnaire completed by maternal participants in 2020.

Results:

Favorable neonatal outcomes were found in 81% of the participants; however, children of mothers with RA had a higher occurrence of favorable outcomes than those with JIA (p = 0.009). Adverse neonatal outcomes reported include the following: small for gestational age (11.6%), intrauterine growth restriction (4.65%), and preterm births (2.75%). There were no incidences of congenital malformations. The mean birth weights of offspring born to mothers with RA are higher than those with JIA (p = 0.00829).

While the majority of the children were breastfed (88.4%), those who were not breastfed were hospitalized more often than those who were breastfed for any period of time (p = 0.03). Mothers who experienced a postpartum flare up within the first 4 months breastfed their children significantly less than those who did not have a flare up (14.62 versus 48 weeks, p = 0.00011).

The mean age of the children at inclusion was 7.6 ± 5.5 years.

Developmental milestones were considered to be within the expected average limits, except for an increased incidence of delayed speech (12%).

51.2% of the children were hospitalized at some point during their childhood, with viral enterocolitis, tonsilitis, bronchiolitis, and pneumonia being the most frequently encountered reasons for admission. Surprisingly, children with favorable neonatal outcomes were hospitalized more often than those with unfavorable outcomes (p = 0.0000436). Additionally, children born to mothers under the age of 35 were hospitalized more often than those over 35 (p = 0.02).

77.3% of offspring experienced recurrent ear/nose/throat (ENT) infections, 55.8% had allergies, and 39.5% were diagnosed with atopic dermatitis. Childhood allergies were strongly associated with an increased incidence of atopic dermatitis (p = 0.0000585), as was a concurrent maternal thrombophilia diagnosis (p = 0.03).

Of the remaining childhood afflictions that were assessed asthma/chronic respiratory diseases (4.65%), juvenile idiopathic arthritis (2.33%), ulcerative colitis (2.33%), diabetes, anxiety/personality disorders, thyroid diseases, febrile seizures, and epilepsy did not yield statistically significant results.

Conclusion:

Maternal RA was found to be associated with increased incidences of adverse neonatal outcomes, childhood hospitalizations, recurrent ENT infections, allergies, and atopic dermatitis. However, overall health outcomes of offspring did not show alarmingly significant excess morbidities.

References:

[1]Rom AL, Wu CS, Olsen J, et al. Parental rheumatoid arthritis and long-term child morbidity: a nationwide cohort study. Annals of the Rheumatic Diseases. 2016;75(10):1831–1837. doi:10.1136/annrheumdis-2015-208072

Disclosure of Interests:

None declared