Common autoimmune diseases include type 1 diabetes, ulcerative colitis, Crohn’s disease and celiac disease, psoriasis, multiple sclerosis, and rheumatoid arthritis, just to name a few.
“Autoimmune diseases are conditions where the immune system falsely ‘attacks’ the body,” said study author Timothy Nielsen, a research associate and PhD student at the Children’s Hospital at the University of Sydney’s Westmead Clinical School. The study was published Tuesday in JAMA Pediatrics.
The attack could result in “a ‘multi-organ’ condition such as lupus, or an ‘organ-specific’ condition such as an autoimmune thyroid disease (Hashimoto’s thyroiditis or Graves’ disease), ” Nielsen said via 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 diseases 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 explore their role in ADHD.
“I hope these findings don’t overemphasize women with autoimmune diseases,” said developing pediatrician 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 these findings wouldn’t change the way I treat them,” Radesky said. “While kids with ADHD can be a handful, I love their little expansive, curious minds and unique ways of seeing things.
“Mothers with an autoimmune disease can work to get the best possible control of their condition during pregnancy, but autoimmune disease is not like smoking during pregnancy – another risk factor for ADHD – that mothers have more direct control over,” added them to it.
Large, longitudinal study
The study followed more than 63,000 full-term children who went to full term 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 diseases. Each of the expectant mothers had a diagnosis code for an autoimmune disease in their linked hospital admissions.
A child was found to have ADHD if there was a diagnosis of ADHD or a record of a prescribed or filled prescription for stimulants in the hospital.
All 12,610 offspring diagnosed with ADHD over 3 years of age were included in the study and then matched with four children of the same age with mothers without autoimmune diseases. Both groups of children were then followed until the end of 2014.
The study also conducted a meta-analysis of existing research on the topic.
Combined, the results have shown that a diagnosis of an 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 the child later in life.
Autoimmune Diseases and Inflammation
Exactly how a mother’s autoimmune disease can affect her unborn baby is not yet known. Researchers hypothesize that maternal autoantibodies – which attack the mother’s body – pass through the placenta. Inflammatory molecules could do the same.
Once there, the chronic inflammation could alter fetal brain development, possibly by affecting innate immune cells in the developing baby’s brain, the study said. Or maybe inflammation alters the epigenetic markers – the chemicals that turn genes on or off – on important neurodevelopmental genes in the fetus.
Another theory, the study said, is that inflammation affects the formation and function of synapses in the baby’s developing brain. Synapses are the small spaces between two cells that allow the cells to transmit and communicate messages.
“These changes can directly lead to ADHD symptoms, or they can make the child more vulnerable to environmental risk factors,” said Nielsen.
Previous research has found that women with autoimmune disease poorly controlled by medication or other treatments may be a risk factor for poor pregnancy outcomes, such as not growing properly and premature birth, Nielsen said.
“Our team is currently investigating the causal mechanisms underlying the association between autoimmune disease and ADHD,” he said, which may shed light on whether the “severity of the disease, symptoms, drug use, or other inflammatory factors affect this risk. of ADHD. “
Knowledge is power
An expectant mother with an autoimmune disease is just one of the many risk factors for any neurodevelopmental disorder in children, Nielsen emphasized, “but understanding the risks and the manifestation of disease is essential if we are to prevent and treat disease.”
The knowledge of such an association could enable both women and their caregivers “to emphasize the importance of high-quality, multidisciplinary care to manage autoimmune diseases before and during pregnancy,” said Nielsen.
“This includes good pre-conception care and possibly the avoidance of pregnancy when disease activity is not well controlled,” he said.
Furthermore, it is no one’s fault if a child develops a condition based on a parent’s medical condition, experts point out.
Sometimes parents will persist in their guilt that a child’s ADHD is their ‘fault’. said pediatrician Radesky.
“When this happens, I try to redirect their mental energy to understand their child’s unique blend of strengths and challenges, why the child behaves the way they do and how to advocate for support,” said they.