title: Increased Risk of Autism Spectrum Disorders in Children Born to Women With Systemic Lupus Erythematosus: Results From a Large Population-Based Cohort.
abstract: OBJECTIVE
  In utero exposure to maternal antibodies and cytokines are potential risk factors for autism spectrum disorders (ASDs). The aim of this study was to determine whether children born to mothers with systemic lupus erythematosus (SLE) have an increased risk of ASD compared to children born to mothers without SLE.
  
  
  METHODS
  The study population was derived from the Offspring of SLE Mothers Registry (OSLER), a large population-based cohort identified through healthcare databases in Quebec (1989-2009) comprising all women who had ≥1 hospitalization for a delivery (stillbirth or live birth) after SLE diagnosis. As general population controls, a randomly selected group of women without SLE was matched ≥4:1 to the mothers with SLE for age and year of delivery. Children born live to mothers with SLE and those born live to matched controls were identified, and a recorded diagnosis of ASD was ascertained for each child. Multivariate analyses were performed to adjust for parents' demographic characteristics, sex, birth order of the child, maternal comorbidities, and obstetric complications.
  
  
  RESULTS
  In total, 509 women with SLE had 719 children, and 5,824 matched controls had 8,493 children. Children born to women with SLE were more frequently found to have a diagnosis of ASD compared to controls (frequency of recorded ASDs 1.4% [95% confidence interval (95% CI) 0.8-2.5] versus 0.6% [95% CI 0.5-0.8]), a difference of 0.8% (95% CI 0.1-1.9). The mean age at ASD diagnosis was younger in offspring of SLE mothers (mean 3.8 years, 95% CI 1.8-5.8) compared to offspring of controls (mean 5.7 years, 95% CI 4.9-6.5). In primary multivariate analysis, SLE offspring had a substantially increased risk of ASD compared to controls (odds ratio 2.19, 95% CI 1.09-4.39).
  
  
  CONCLUSIONS
  Compared to children from the general population, children born to women with SLE have an increased risk of ASD, although, in absolute terms, it represents a rare outcome. These hypothesis-generating data provide direction for additional studies of maternal autoimmunity and ASD risk.
authors: McGill University Health Centre, Montreal, Quebec, Canada.
authors: Évelyne
authors: É
authors: Vinet
authors: McGill University Health Centre, Montreal, Quebec, Canada.
authors: Christian A
authors: CA
authors: Pineau
authors: University of Calgary, Calgary, Alberta, Canada.
authors: Ann E
authors: AE
authors: Clarke
authors: McGill University Health Centre, Montreal, Quebec, Canada.
authors: Susan
authors: S
authors: Scott
authors: Oregon Health & Sciences University, Portland.
authors: Éric
authors: É
authors: Fombonne
authors: McGill University Health Centre and McGill University, Montreal, Quebec, Canada.
authors: Lawrence
authors: L
authors: Joseph
authors: McGill University, Montreal, Quebec, Canada.
authors: Robert W
authors: RW
authors: Platt
authors: McGill University Health Centre, Montreal, Quebec, Canada.
authors: Sasha
authors: S
authors: Bernatsky
mesh_terms: D000328:Adult; D000067877:Autism Spectrum Disorder / Q000453:epidemiology*; D001499:Bayes Theorem; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology*; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors