Neither overall childhood mortality nor case fatality after respiratory or infectious diseases were elevated in the offspring of parents with rheumatoid arthritis (RA), according to a Danish study.
Overall mortality rates were very similar for exposed (maternal or paternal RA, hazard ratio 0.98, 95% CI 0.84-1.15) and for unexposed children (HR 1.08, 95% CI 0.86-1.36), reported Ane L. Rom, PhD, MPH, of Copenhagen University Hospital, and colleagues.
The risk of death in children younger than 5 years, 3 years, or 1 year was also not elevated, they wrote in Arthritis Care & Research.
"Our findings are reassuring since the same cohort of exposed children had excess morbidity for a large number of diseases," they stated.
The authors previously reported more long-term morbidity across eight of 11 diagnostic groups in the same cohort of RA-exposed children.
"While the authors' prior study found that there is an increase in morbidity, these new findings will allow us to offer reassurance to our RA patients with regard to the potential effects in their children," commented Jennifer Murphy, MD, of Low Country Rheumatologists in North Charleston, S.C., to MedPage Today. Murphy was not involved in the study.
Separate research has shown that autoimmune diseases aggregate in families, especially in first-degree relatives, suggesting shared genetic risk among autoimmune diseases and perhaps increased susceptibility toward diseases in general, the authors noted.
They also cited research indicating an association between maternal RA and adverse pregnancy outcomes such as preterm birth and low birth weight. There also has been some suggestion of an increased risk of detrimental outcomes in the children of women with RA, including type 1 diabetes and rapid catch-up growth in the first year of life, which may raise the risk of cardiovascular diseases in early adulthood.
"No study has been conducted on general mortality or case fatality in children of parents with RA," Rom's group wrote. "In the present study, we aimed to assess the overall child mortality and the risk of death after common childhood diseases, i.e., respiratory and infectious diseases in the same cohort of children."
The study cohort was drawn from all singletons born in Denmark from 1977 to 2008. Of the 1,917,723 newborns, followed to 2009 for an average of 16 years and a maximum of 32, 13,556 were exposed to maternal RA and 6,330 to paternal RA.
Compared with unexposed children, the exposed children had mothers with less education at time of giving birth, but maternal and paternal ages at birth were similar for exposed and unexposed children (around 28 for both). These characteristics were comparable for the children diagnosed with respiratory (n=6,352) or infectious (n=3,484) disease and followed to age 5.
During 1977-2009, there were 17,757 deaths in the cohort. In the under-5 age group, 6,106 with RA parents were diagnosed with respiratory diseases and 3,320 with infectious diseases.
Case fatalities in these two disease groups (HR 1.11, 95% CI 0.74-1.66) were not significantly higher than those in unexposed children (HR 0.84. 95% CI 0.52-1.35).
However, in children born after 1995, the study found a two-fold higher mortality risk among the offspring of fathers with RA, but the estimate was based on just 13 deaths, the authors cautioned.
A study limitation was the small number of deaths (231) among RA-exposed children, which was reflected in the wide confidence intervals. "Furthermore, we do not know if these children will develop diseases with higher mortality later in life, since the children were followed to a maximum of 32 years of age," Rom and associates wrote.
Although they adjusted for potential confounders, unmeasured or residual confounding may still exist.
"Future studies are needed in children of parents with RA to assess their health in adulthood," the authors wrote.
Rom disclosed supported from the National Institutes of Health, the Danish Council for Independent Research, and the Augustinus Foundation.
Rom and co-authors disclosed no relevant relationships with industry.
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