Common autoimmune disorders include type 1 diabetes, ulcerative colitis, Crohn’s disease and celiac disease, psoriasis, multiple sclerosis and rheumatoid arthritis, to name a few.
“Autoimmune diseases are disorders in which the immune system incorrectly ‘attacks’ the body,” said study author Timothy Nielsen, a research officer and doctoral student at Children’s Hospital Westmead Clinical School at the University of Sydney. The study was published Tuesday in JAMA Pediatrics.
The attack can result in “a” multi-organic “disorder, such as lupus, or a” specific organic “disorder, such as autoimmune thyroid disease (Hashimoto’s thyroiditis or Graves’ disease),” Nielsen said in an email.
Neurodevelopmental disorders such as ADHD, learning disabilities and autism are caused by disruptions in fetal brain development during pregnancy, Nielsen said. Previous research has linked autoimmune disorders in mothers with autism, obsessive-compulsive disorder and tics or Tourette’s syndrome in children, he said, but this is one of the first studies to examine their role in ADHD.
“I hope these findings don’t stress women with autoimmune diseases too much,” said pediatric developmental physician Dr. Jenny Radesky, an assistant professor of pediatrics at Michigan Medicine CS Mott Children’s Hospital, who was not involved in the study.
“I treat a lot of children with ADHD and those findings wouldn’t change the way I manage them,” Radesky said. “Although children with ADHD can be a hand, I like their slightly expansive, curious minds and unique ways of seeing things.
“Mothers with autoimmune diseases can work to have optimal control of their condition during pregnancy, but autoimmune disease is not like smoking during pregnancy – another risk factor for ADHD – over which mothers have more direct control,” she said. she added.
Large longitudinal study
The study followed more than 63,000 full-term babies born between July 1, 2000 and December 31, 2010, in New South Wales, Australia. Nielsen and his team identified 12,610 mothers with at least one of the 35 common autoimmune disorders. Each of the expectant mothers had a diagnostic code for an autoimmune disorder in their hospitalization records.
A child was determined to have ADHD if there was a hospital diagnosis of ADHD or a record of a prescription prescribed or supplemented for incentives.
All 12,610 offspring who were diagnosed with ADHD over the age of 3 were included in the study and then associated with four children of the same age with mothers without autoimmune disorders. Both sets of children were then followed until the end of 2014.
The study also conducted a meta-analysis of existing research on this topic.
Combined, the results showed that a diagnosis of any autoimmune disease, type 1 diabetes, rheumatic fever or rheumatic carditis (inflammation of the heart muscle), psoriasis and hyperthyroidism were associated with an increased risk of ADHD in children at a later age.
Autoimmune disorders and inflammation
It is not yet known how a mother’s autoimmune disorder could affect her unborn baby. Researchers hypothesize that maternal autoantibodies – those that attack the mother’s body – cross the placenta. Inflammatory molecules could do the same.
Once there, chronic inflammation could alter the development of the fetal brain, possibly through the impact of innate immune cells in the developing baby’s brain, the study said. Or maybe the inflammation changes the epigenetic markers – the chemicals that activate or deactivate genes – on key genes of neurodevelopment in the fetus.
Another theory, the study said, is that inflammation impacts the formation and function of synapses in the baby’s developing brain. Synapses are the small pockets of space between two cells that allow cells to transmit messages and communicate.
“These changes can lead directly to ADHD symptoms or make the child more vulnerable to environmental risk factors,” Nielsen said.
Previous research has found that women with autoimmune diseases that are poorly controlled by drugs or other treatments could be a risk factor for poor pregnancy outcomes, such as failure to grow properly and premature birth, Nielsen said.
“Our team is currently researching the causal mechanisms underlying the association between autoimmune diseases and ADHD,” he said, which could shed light on the severity of the disease, symptoms, medication use or other inflammatory factors. of ADHD. “
Knowledge is power
A pregnant mother with an autoimmune disorder is just one of many risk factors for any childhood neurodevelopmental disorder, Nielsen said, “but understanding the risk and expressing the disease is essential if we are to prevent and treat the disease.”
Knowledge of such an association can empower both women and their healthcare providers to “emphasize the importance of high-quality multidisciplinary care to manage autoimmune conditions before and during pregnancy,” Nielsen said.
This includes good pre-conception care and possibly avoiding pregnancy when disease activity is not well controlled, he said.
In the past, it is not anyone’s fault if a child develops a disorder based on a parent’s medical condition, experts point out.
“Sometimes parents will persevere in their guilt because a child’s ADHD is their ‘fault.’ “Developing pediatrician Radesky said.
“When this happens, I try to redirect their mental energy to understanding their child’s unique mix of strengths and challenges, why the child is behaving the way they are behaving and how to advocate for support,” she said.