FRI0060 NEUROCOGNITIVE PROFILE IN CHILDREN BORN TO MOTHERS WITH CHRONIC ARTHRITIS: WHICH RELATIONSHIP WITH MATERNAL FEELING OF DISEASE?
Authors: Cecilia Nalli, Jessica Galli, Angela Merlini, Chiara Asperti, Laura Andreoli, Elisa Fazzi, Angela Tincani
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Chronic Arthritis could begin in women in childbearing age with several consequent complications in family planning. There are few data on long term outcome of children born from these mothers. <h3>Objectives</h3> Evaluate the neurocognitive profile of children born to mothers with Rheumatoid Arthritis (RA), Psoriasic Arthritis (PsA), Ankylosing Spondylitis (SpA) and studied the psychological outcome of these patients in relationship to their pregnancies. <h3>Methods</h3> We evaluated 16 women (11 RA, 3 PsA, 2 SpA) with diagnosis before pregnancy and school-age children. Information about maternal disease and treatment during pregnancy were collected from medical records. The work was performed by a multidisciplinary team (rheumatologists and pediatric neurologists). The Child Behavior Check List (CBCL 6-18), a home-made questionnaire and others validate questionnaires (STATE-TRAIT ANXIETY INVENTORY - STAI, EDIMBURGH POSTNATAL DEPRESSION SCALE - EPDS, PAYKEL scale of stressful life events) were submitted to all mothers. A neurological physical exam was performed by a pediatric neurologist in all children. Intellectual functioning were assessed by Wechsler scale for corrected age. We also applied standardized batteries to evaluate academic learning. The study was approved by the local ethical committee. <h3>Results</h3> We evaluated 18 children (F/M=1/1, median age 7,4 years, range 6.4-14). All children were born at term and with normal weight. The neurological physical exam and the intelligence level were normal in all children. One child displayed a specific learning disability in reading activities (10% vs 2,5-3,5% of general pediatric population). We found in 6 children (33%) behavior aspects of somatization and anxiety/depression (internalizing problem), in 2 (11%) externalizing problems (oppositional-provocative behavior) and in 5 (28%) an "adult profile". From maternal evaluations we found significant correlations between activity of disease during pregnancy and difficult caregiving and breastfeeding (p=0,005 and p=0,0128 respectively). Finally, a relationship also exists between maternal depression/anxiety and need of psychological support. <h3>Conclusion</h3> This preliminary study on children born to mothers with chronic arthritis showed in children a prevalent pattern of anxiety/depression and an adult, mature profile, expression of insecurity. Therefore, data from CBCL showed that these children were less involved in sports or playful activities than peers and were more involved in school activities. It seemed they would invest more energies in intellectual functioning, as noted in children affected by chronic diseases such as asthma or juvenile idiopathic arthritis. On the maternal side clearly emerged a diffuse state of anxiety, accentuated by having an active disease during pregnancy and puerperium. Postpartum depression was detected in these mothers with higher levels than general population (39% vs 10-15%): it could be desiderable to give these mothers a psychological support during this period. The practical message of our study is also that children born to women with chronic arthritis may need a long-term followup in order to detect and correct any neurological, behavioral or cognitive alteration as early as possible. <h3>Reference</h3> [1] Bomba M, Galli J, Nacinovich R, et al. Neuropsychiatric aid in children born to patients with rheumatic diseases. Clin Exp Rheumatol. 2010 Sep-Oct;28(5):767-73. <h3>Disclosure of Interests</h3> Cecilia Nalli: None declared, Jessica Galli: None declared, Angela Merlini: None declared, Chiara Asperti: None declared, Laura Andreoli: None declared, Elisa Fazzi: None declared, Angela Tincani Consultant for: UCB, Pfizer, Abbvie, BMS, Sanofi, Roche, GSK, AlphaSigma, Lillly, Jannsen, Cellgene, Novartis