Increased usage of special educational services by children born to mothers with systemic lupus erythematosus and antiphospholipid antibodies.
BACKGROUND
Surveys of long-term health and developmental outcomes of children born to mothers with systemic lupus erythematosus (SLE) have suggested an increase in learning disabilities among these children. We performed this observational study to investigate the relationship between maternal autoantibodies and antiphospholipid antibody syndrome (APS) in maternal lupus patients and neurocognitive development among their offspring.


METHODS
SLE mothers with at least one live birth postlupus diagnosis were enrolled. Data on maternal medical/obstetric history and children's perinatal/medical history were collected by structured interview and medical record reviews. The primary outcome was requirement for special educational (SE) services, a proxy for developmental delays. Multiple logistic regression modelling was used to examine associations between APS and autoantibodies with SE usage, accounting for SLE disease severity and potential confounders.


RESULTS
Data on 38 mothers and 60 offspring were analysed: SE service usage was reported for 15 of 60 (25%) offspring. Maternal APS history was significantly associated with increased use of SE services among offspring, including after adjustment for lupus anticoagulant (LA) positivity and potential confounders (OR 5.5-9.4 for delays age ≥2; p<0.05). The presence of LA, but not other antiphospholipid antibodies, was also associated with increased SE services usage.


CONCLUSIONS
Maternal APS and LA were independently associated with increased usage of special educational services among offspring of women with SLE.
Department of Internal Medicine, Division of Rheumatology , University of Michigan , Ann Arbor, Michigan , USA ; Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine , University of Michigan , Ann Arbor, Michigan , USA.
Wendy
W
Marder
Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine , University of Michigan , Ann Arbor, Michigan , USA.
Vivian C
VC
Romero
Department of Internal Medicine, Division of Rheumatology , University of Michigan , Ann Arbor, Michigan , USA.
Martha A
MA
Ganser
Department of Internal Medicine, Division of Rheumatology , University of Michigan , Ann Arbor, Michigan , USA.
Margaret A
MA
Hyzy
School of Immunity and Infection, University of Birmingham , Birmingham , UK.
Caroline
C
Gordon
Department of Internal Medicine, Division of Rheumatology , University of Michigan , Ann Arbor, Michigan , USA.
W J
WJ
McCune
Department of Internal Medicine, Division of Rheumatology , University of Michigan , Ann Arbor, Michigan , USA ; Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine , University of Michigan , Ann Arbor, Michigan , USA ; Department of Environmental Health Sciences , University of Michigan , Ann Arbor, Michigan , USA.
Emily C
EC
Somers
Antiphospholipid Antibodies; Antiphospholipid Syndrome; Autoantibodies; Outcomes research; Systemic Lupus Erythematosus