For Lupus Warriors considering becoming pregnant, the health and safety of their future child is a major concern. Previous research has identified that children of people with lupus experience an increased risk of some neuro-developmental disorders. But, the impact of those risks on overall cognitive performance was poorly understood. A new study looked at the longitudinal school performance of children of Lupus Warriors to better understand the risks.
This study was performed by the Department of Public Health at Aarhus University in Denmark, and tracked 738,862 Danish children over 6 years. Participants were included from 1995-2008. The researchers assessed children’s performance on national school tests from 2nd to 8th grade.
312 of these children in the cohort had biological mothers with systemic lupus erythematosus (SLE). 1,235 children were born to mothers who took the lupus medication hydroxychloroquine. The researchers compared linked healthcare registries to identify the child and mother pairs, which was possible due to the healthcare policies in Denmark.
After assessment over those 6 years, there were no differences in tests of reading or mathematics between these children and the “baseline” children.
31 of the children who had mothers with lupus were also exposed to hydroxychloroquine or immunosuppressants in-utero, and these did have slightly poorer test results, but this result was not considered statistically significant. The researchers concluded: “This study indicates no major harmful effect on the child’s neurocognitive development from exposure in utero to SLE, hydroxychloroquine and/or immunosuppressants, as measured by school performance”
In other words, the children of mothers who had lupus were not found in this study to have a higher rate of reading issues or math difficulties. Where it relates to cognition as measured by school performance, these children were fine.
The Need for Research
Previous studies of the children of people with lupus found indications that SLE in pregnancy was linked to a threefold (3x) increased risk of learning disabilities or other cognitive development challenges. Specifically, children of Lupus Warriors experience an increased risk of autism spectrum disorders, dyslexia, and ADHD.
Researchers proposed that the high levels of inflammation and many of the medications involved in SLE could be the cause. And affecting the child while they are developing in the uterus.
A 1997 study evaluated 47 children of women with SLE and diagnosed learning disabilities, including dyslexia. A systemic review of these studies in 2017 also linked SLE in development to autism spectrum disorders, language delays, and speech disorders. A 2003 study saw some higher rates of learning disabilities in male children versus female children of mothers with lupus.
The children’s IQs were within a normal range, however. And, this study did not look at the long-term cognitive abilities of the children. Which is their ability to think, reason, and solve problems. These skills are vital to success in life.
Research in Context
Overall, the children of women with lupus do not appear to have high rates of long-term cognitive issues despite the other risks.
Pregnancy in lupus is something that should be considered with care for other reasons. Pregnancies with lupus have a higher risk of complications, which can independently increase the risk of learning disabilities. This increased risk of learning disability is more heavily influenced by genetics.
SLE also has a genetic component. Children of people with lupus are more likely to have lupus and other autoimmune diseases. This risk is not a certainty, however, and access to medical care can help reduce these risks further.
What about Neonatal Lupus?
Children can develop lupus at a young age (childhood-onset lupus). The risk is higher in the children of mothers with SLE.
There is a rare condition called Neonatal Lupus. This is a lupus-like condition that results in skin rashes and other complications after birth. It is caused by autoimmune activity, like lupus. And mothers with SLE have a higher risk of having children with this condition. Neonatal lupus generally clears up on its own, but can come with a serious condition called cardiac heart block.
Neonatal lupus has nothing to do with the cognitive development of children. But it is a potential complication of pregnancy during lupus.
With the appropriate services, both chronic illness and learning disabilities can be handled. Medical care can help with pregnancy complications. However, these are all things to keep in mind for women with lupus who are considering a family.
Many lupus treatment teams recommend family planning strategies to have some control over the situation.
So, What’s the Verdict on Cognitive Development and Lupus?
There are many things to consider about pregnancy for women with lupus, but it seems that a risk of long-term neurological damage or disability is not one of them.
In fact, the children of people with SLE are most often healthy – however, it is worth discussing with one’s partner and lupus treatment team, and making plans for a new arrival.
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