Maternal Systemic Lupus Erythematosus May Increase Risk for Childhood Asthma

Children of mothers with systemic lupus erythematosus (SLE) have an increased risk for asthma, according to a comprehensive cohort study published in Arthritis Care & Research.¹

High concentrations of immunoglobulin E have been associated with SLE, and similar immunoglobulin E-mediated mechanisms are involved in the development of asthma.^1-3 Therefore, researchers compared 775 children born to mothers with SLE and 11,225 children born to mothers without SLE using data from medical registers in Sweden from 2001 to 2003.¹ Children of mothers with SLE were 4 to 5 times more likely to be born preterm (<37 weeks gestation) compared with children of mothers without SLE. However, the prevalence of obesity and history of smoking and asthma were similar among the mothers regardless of SLE diagnosis.

The results of this study indicate that the rate of asthma developing is 46% higher in children born to mothers with SLE, and that children of mothers with SLE who smoked during pregnancy have the highest risk for asthma developing.¹ Previous studies have identified smoking as a risk factor for SLE as well as for preterm birth.^4,5 In the present study, 29% of the association between maternal SLE and childhood asthma was mediated by preterm delivery.¹ Therefore, the majority of the correlation between maternal SLE and childhood asthma remains unresolved.

Although there may have been some limitations to this study, including the possibility of misclassification of maternal SLE, it has several strengths, including its size. The authors concluded that, “Prevalent maternal SLE during pregnancy is associated with an increased risk of asthma in the offspring. While preterm birth can explain a fair proportion of this association, additional unidentified mechanisms are also likely to play a role.”

References

1. Rossides M, Nguyen C, Arkema EV, Simard JF. Asthma in children of mothers with systemic lupus erythematosus and the role of preterm birth [published online November 10, 2017]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.23472
2. Dema B, Pellefigues C, Hasni S, et al. Autoreactive IgE is prevalent in systemic lupus erythematosus and is associated with increased disease activity and nephritis. PLoS One. 2014;9:e90424.
3. Henault J, Riggs JM, Karnell JL, et al. Self-reactive IgE exacerbates interferon responses associated with autoimmunity. Nat Immunol. 2016;17:196-203.
4. Costenbader KH, Kim DJ, Peerzada J, et al. Cigarette smoking and the risk of systemic lupus erythematosus: a meta-analysis. Arthritis Rheum. 2004;50:849-857.
5. Shah NR, Bracken MB. A systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery. Am J Obstet Gynecol. 2000;182:465-472.