Maternal Autoimmune Disease

Australian researchers have found a potential link between ADHD in children and maternal autoimmune disease. Image courtesy of Kids’ Health.

An Australian study has found a potential link between autoimmune disease and attention deficit hyperactivity disorder (ADHD).

The study took place over a decade, from 2000 to 2010, following more than 63,000 children born at full-term in New South Wales, Australia. Study author Timothy Nielsen, a PhD candidate at the University of Sydney, said that they were able to identify 12,610 mothers who had one or more of 35 common autoimmune diseases, such as type 1 diabetes, celiac disease, Crohn’s, psoriasis, multiple sclerosis, lupus, Sjogren’s or rheumatoid arthritis, to name a few. The children were identified as having a diagnosis of ADHD, or a prescription for stimulants.

The study also included a meta-analysis of existing research on this topic. The combined results of the longitudinal study and the meta-analysis found that when the mother had a diagnosis of any autoimmune disease, [this was] associated with a higher risk of ADHD in their child at later ages.

While researchers don’t know the exact reason why women with autoimmune disorders are more likely to have children with ADHD, researchers do have a hypothesis. It’s believed that maternal autoantibodies, which attack the mother’s own tissues, cross the placenta into the unborn fetus during pregnancy. Inflammatory molecules, therefore, could potentially do the same. These molecules could, in turn, alter fetal brain development, either by altering epigenetic markers, which turn certain genes on or off, or by impacting the function and formation of synapses, which allow nerve cells to communicate.

Nielsen explained, “These changes may lead directly to ADHD symptoms, or they may make the child more vulnerable to environmental risk factors.” He continued, “Our team is currently working on research into the causal mechanisms that underlie the association between autoimmune disease and ADHD, which may shed light on whether the severity of disease, symptoms, use of medications or other inflammatory factors modifies the risk of ADHD.”

This is the first study that explores the correlation between maternal autoimmune disease and the risk of ADHD in children. Other research has shown a link between autoimmune disease in mothers and other neurodevelopmental disorders, such as autism, obsessive-compulsive disorder (OCD), tics and Tourette’s syndrome.

Read the original study published in JAMA Pediatrics here: Association of Maternal Autoimmune Disease with ADHD in Children.

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*Congenital Heart Block (CHB) is a rare but serious condition that occurs more frequently in newborns born to mothers with autoimmune disease.* *Image courtesy of Insider.com.*

What is Congenital Heart Block?

According to the National Organization for Rare Disease, Congenital Heart Block, or CHB for short, is the interference of the transfer of electric nerve impulses that regulate the pumping of the heart muscle.

As long as electrical impulses are transmitted normally between the heart’s chambers – the atria and the ventricles – the heart contracts normally, allowing for blood to be pumped throughout the body. If the transmission of the signal is impeded, the blocked electrical transmission is known as heart block, or atrioventricular (AV) block.

Though heart block can happen to anyone of any age, it is called congenital heart block if it occurs in a fetus or newborn up to 28 days old.

Why Does CHB Occur in Children Born to Women with Autoimmune Disease?

Autoimmune-associated CHB has been found in a variety of maternal autoimmune disorders, including Sjogren’s syndrome, systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid syndrome (APS), mixed connective tissue disorders, and undifferentiated connective tissue disease.

It is believed that CHB may result when maternal antibodies cross the placenta, enter the fetus, and attack the fetal cardiac conduction system. The antibodies that were originally produced by the mother’s body to fight infections mistakenly recognize parts of the fetal heart’s conduction system as foreign; for this reason, the immune system attacks and damages the tissues, resulting in inflammation and scarring, which in turn leads to faulty conduction.

What Is the Risk of Congenital Heart Block if I Have an Autoimmune Disease?

A 2017 study conducted by Chinese medical professionals Kai-Yu Zhou and Yi-Min Hua of the West China Second University Hospital, Department of Pediatric Cardiology, revealed that more than half of CHB cases (between 60 and 90%) are associated with maternal autoimmune disease.

Among the general population, CHB occurs in 1 out of every 20,000 live births – an incidence of only 0.00005%. The study found that autoimmune-associated CHB, however, occurs at much more frequent rates, affecting between 2–5% pregnancies with positive anti-Ro/SSA and La/SSB antibodies. The study also found that when a woman had a child with CHB, the recurrence rate of CHB was 12–25% for a subsequent pregnancy.

Mortality Rate & Treatment for Congenital Heart Block

The perinatal mortality rate of a newborn with CHB is up to 30%, and even higher in the presence of endocardial fibroelastosis (EFE) or dilated cardiomyopathy (DCM), which are other potential complications associated with CHB.

If CHB is detected in utero by a fetal electrocardiography (ECG) and echocardiography, your OB/GYN may prescribe an adrenocorticosteroid such as dexamethasone, which works to decrease inflammation and the number of circulating maternal antibodies in the fetus.

Once born, other studies have shown that between that 64 and 70% of CHB survivors require surgery to permanently implant a pacemaker, a medical device which stimulates the heart to contract so that it can pump blood.

How to Prevent Congenital Heart Block

A 2016 report by the American College of Rheumatology states that there are no official guidelines about the prevention, screening, and treatment of CHB due to maternal Ro antibodies.

However, in the same report, it was stated that in a survey of 330 women with autoimmune conditions, 67% were told by their rheumatologists to use hydroxychloroquine (also known as Plaquenil) to prevent CHB. In addition, 62% were told to start the drug prior to pregnancy, in order to prevent the condition from developing.

Another study published in The Journal of the American College of Cardiology stated that hydroxychloroquine reduces the recurrence of CHB below the historical rate by more than 50%, further demonstrating the promise of this drug in the prevention of CHB.

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Study Reveals Increased ADHD Risk in Children Born to Mothers with Autoimmune Disease