Systemic Lupus Erythematosus
In Utero Azathioprine Exposure and Increased Utilization of Special Educational Services in Children Born to Mothers With Systemic Lupus Erythematosus
Article first published online: 23 APR 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 5, pages 759–766, May 2013
How to Cite
Marder, W., Ganser, M. A., Romero, V., Hyzy, M. A., Gordon, C., McCune, W. J. and Somers, E. C. (2013), In Utero Azathioprine Exposure and Increased Utilization of Special Educational Services in Children Born to Mothers With Systemic Lupus Erythematosus. Arthritis Care Res, 65: 759–766. doi: 10.1002/acr.21888
- Issue published online: 23 APR 2013
- Article first published online: 23 APR 2013
- Accepted manuscript online: 8 NOV 2012 01:13PM EST
- Manuscript Accepted: 14 OCT 2012
- Manuscript Received: 6 JUL 2012
- Herbert and Carol Amster Lupus Research Fund
- Michael and Marcia Klein Lupus Research Fund
- NIH. Grant Number: K12HD001438
- National Center for Research Resources. Grant Number: UL1RR024986
Azathioprine (AZA) is recognized among immunosuppressive medications as relatively safe during pregnancy for women with systemic lupus erythematosus (SLE) requiring aggressive treatment. This pilot study aimed to determine whether SLE therapy during pregnancy was associated with developmental delays in offspring.
This cohort study included SLE patients with at least one live birth postdiagnosis. Medical histories were obtained via interviews and chart review. Multiple logistic regression was used to examine associations between SLE therapy during pregnancy and maternal report of special educational (SE) requirements (as proxy for developmental delays) among offspring. Propensity scoring (incorporating corticosteroid use, lupus flare, and lupus nephritis) was used to account for disease severity.
Of 60 eligible offspring from 38 mothers, 15 required SE services, the most common indication for which was speech delay. Seven (54%) of the 13 children with in utero AZA exposure utilized SE services versus 8 (17%) of 47 nonexposed children (P < 0.01). After adjustment for pregnancy duration, small for gestational age, propensity score, maternal education level, and antiphospholipid antibody syndrome, AZA was significantly associated with SE utilization occurring from age 2 years onward (odds ratio 6.6, 95% confidence interval 1.0–43.3), and bordered on significance for utilization at any age or age <2 years.
AZA exposure during SLE pregnancy was independently associated with increased SE utilization in offspring, after controlling for confounders. Further research is indicated to fully characterize developmental outcomes among offspring with in utero AZA exposure. Vigilance and early interventions for suspected developmental delays among exposed offspring may be warranted.