Risk Factors for Juvenile Dermatomyositis: Exposure to Tobacco and Air Pollutants During Pregnancy
Article first published online: 25 SEP 2014
Copyright © 2014 by the American College of Rheumatology
Arthritis Care & Research
Volume 66, Issue 10, pages 1571–1575, October 2014
How to Cite
Orione, M. A. M., Silva, C. A., Sallum, A. M. E., Campos, L. M. A., Omori, C. H., Braga, A. L. F. and Farhat, S. C. L. (2014), Risk Factors for Juvenile Dermatomyositis: Exposure to Tobacco and Air Pollutants During Pregnancy. Arthritis Care Res, 66: 1571–1575. doi: 10.1002/acr.22358
- Issue published online: 25 SEP 2014
- Article first published online: 25 SEP 2014
- Accepted manuscript online: 22 APR 2014 12:41PM EST
- Manuscript Accepted: 15 APR 2014
- Manuscript Received: 15 DEC 2013
- Conselho Nacional de Desenvolvimento Científico e Tecnológico. Grant Numbers: 472155/2012-1, 302724/2011-7
- Federico Foundation
- Núcleo de Apoio à Pesquisa “Saúde da Criança e do Adolescente” da Universidade de São Paulo
To evaluate the influence of exposure to inhaled environmental factors during pregnancy on the diagnosis of juvenile dermatomyositis (DM).
We performed a case–control study comprising 20 juvenile DM patients and 56 healthy controls matched by age and sex who were residents in the metropolitan region of a large city. A questionnaire assessed demographic data and environmental inhalation exposure during pregnancy (occupational exposure to demolition, chalk, construction and/or quarry dust, paints, varnish, gasoline vapor, and/or battery fluids; stationary sources of inhaled pollution near the mother's home; and maternal tobacco exposure). Daily concentrations of inhaled particulate matter, SO2, NO2, O3, and carbon monoxide (CO) were evaluated throughout the gestational period.
Maternal occupational exposure to school chalk dust/gasoline vapor in the juvenile DM group was significantly higher compared with controls (50% versus 4.6%; P = 0.001). Smoking mothers and secondhand smoke exposure at home during pregnancy were significantly higher in the juvenile DM group versus controls (smoking mothers: 20% versus 1.7%; P = 0.01, and secondhand smoke: 35% versus 19%; P = 0.07). In univariate logistic regression models, maternal smoking, occupational exposure to inhaled agents, and the highest tertile of tropospheric CO (3.2–5.4 parts per million) in the third trimester were significantly associated with juvenile DM (P ≤ 0.05). In the multivariate analysis, smoking mother (odds ratio [OR] 13.26 [95% confidence interval (95% CI) 1.21–144.29], P = 0.03), occupational exposure (OR 35.39 [95% CI 1.97–632.80], P = 0.01), and CO (third tertile) exposure in the third trimester of gestation (OR 12.21 [95% CI 1.28–115.96], P = 0.03) remained risk factors for juvenile DM.
Inhaled pollutants and tobacco smoking during fetal development may contribute to juvenile DM.