Association between maternal systemic lupus erythematosus and infant infection: a population-based cohort study in Sweden
Objectives The objectives of the study are to investigate infection risk in offspring born to women with systemic lupus erythematosus (SLE) compared with offspring born to women without SLE and examine the mediating role of preterm birth.Design This is a register-based cohort study.Setting Liveborn...
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/12/e090555.full |
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| author | Elisabet Svenungsson Elizabeth V Arkema Sofie A M Gernaat Maria Altman Julia F Simard |
| author_facet | Elisabet Svenungsson Elizabeth V Arkema Sofie A M Gernaat Maria Altman Julia F Simard |
| author_sort | Elisabet Svenungsson |
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| description | Objectives The objectives of the study are to investigate infection risk in offspring born to women with systemic lupus erythematosus (SLE) compared with offspring born to women without SLE and examine the mediating role of preterm birth.Design This is a register-based cohort study.Setting Liveborn singletons born in Sweden, 2006–2021, were included in the study.Participants 1248 infants born to mothers with SLE (≥2 International Classification of Diseases-coded visits in the National Patient Register (NPR) and Medical Birth Register, with ≥1 visit before pregnancy) and 34 886 infants born to women without SLE from the general population were included.Primary and secondary outcome measures The primary outcome was any visit for infection in the NPR or anti-infectives in the Prescribed Drug Register. The secondary outcome was hospitalised infection. Infection risks within 72 hours, within 1 month and within 1 year were estimated.Results SLE offspring had a higher risk of infection in the first 72 hours compared with non-SLE (2.1% vs 1.2%; risk ratios (RR) (95% CI) 1.62 (1.09 to 2.42)), the first month (5.2% vs 4.5%; RR 1.12 (0.88 to 1.43)) and first year of life (38.2% vs 37.2%; RR 1.09 (1.01 to 1.17)). The hospitalised infection risk for SLE offspring was similar to that of non-SLE (5.8% vs 5.5%, first year of life). The percentage of the total effect of maternal SLE on infant infection mediated through preterm birth was 86% for infection in the first 72 hours and 27% in the first year of life.Conclusions The risk of infection in SLE offspring is most increased in the first 3 days after birth, and a proportion of this association can be explained by preterm birth. To prevent early neonatal infections, maternal SLE could be considered as a risk factor before allowing early discharge from postnatal care. |
| format | Article |
| id | doaj-art-5efbfb1b16e74bb8ae1c1981e0329d50 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-5efbfb1b16e74bb8ae1c1981e0329d502025-08-20T02:35:18ZengBMJ Publishing GroupBMJ Open2044-60552024-12-01141210.1136/bmjopen-2024-090555Association between maternal systemic lupus erythematosus and infant infection: a population-based cohort study in SwedenElisabet Svenungsson0Elizabeth V Arkema1Sofie A M Gernaat2Maria Altman3Julia F Simard45 Department of Medicine Solna, Rheumatology Division, Karolinska Institutet, Stockholm, Stockholm, Sweden1 Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden1 Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden1 Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden1 Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, SwedenObjectives The objectives of the study are to investigate infection risk in offspring born to women with systemic lupus erythematosus (SLE) compared with offspring born to women without SLE and examine the mediating role of preterm birth.Design This is a register-based cohort study.Setting Liveborn singletons born in Sweden, 2006–2021, were included in the study.Participants 1248 infants born to mothers with SLE (≥2 International Classification of Diseases-coded visits in the National Patient Register (NPR) and Medical Birth Register, with ≥1 visit before pregnancy) and 34 886 infants born to women without SLE from the general population were included.Primary and secondary outcome measures The primary outcome was any visit for infection in the NPR or anti-infectives in the Prescribed Drug Register. The secondary outcome was hospitalised infection. Infection risks within 72 hours, within 1 month and within 1 year were estimated.Results SLE offspring had a higher risk of infection in the first 72 hours compared with non-SLE (2.1% vs 1.2%; risk ratios (RR) (95% CI) 1.62 (1.09 to 2.42)), the first month (5.2% vs 4.5%; RR 1.12 (0.88 to 1.43)) and first year of life (38.2% vs 37.2%; RR 1.09 (1.01 to 1.17)). The hospitalised infection risk for SLE offspring was similar to that of non-SLE (5.8% vs 5.5%, first year of life). The percentage of the total effect of maternal SLE on infant infection mediated through preterm birth was 86% for infection in the first 72 hours and 27% in the first year of life.Conclusions The risk of infection in SLE offspring is most increased in the first 3 days after birth, and a proportion of this association can be explained by preterm birth. To prevent early neonatal infections, maternal SLE could be considered as a risk factor before allowing early discharge from postnatal care.https://bmjopen.bmj.com/content/14/12/e090555.full |
| spellingShingle | Elisabet Svenungsson Elizabeth V Arkema Sofie A M Gernaat Maria Altman Julia F Simard Association between maternal systemic lupus erythematosus and infant infection: a population-based cohort study in Sweden BMJ Open |
| title | Association between maternal systemic lupus erythematosus and infant infection: a population-based cohort study in Sweden |
| title_full | Association between maternal systemic lupus erythematosus and infant infection: a population-based cohort study in Sweden |
| title_fullStr | Association between maternal systemic lupus erythematosus and infant infection: a population-based cohort study in Sweden |
| title_full_unstemmed | Association between maternal systemic lupus erythematosus and infant infection: a population-based cohort study in Sweden |
| title_short | Association between maternal systemic lupus erythematosus and infant infection: a population-based cohort study in Sweden |
| title_sort | association between maternal systemic lupus erythematosus and infant infection a population based cohort study in sweden |
| url | https://bmjopen.bmj.com/content/14/12/e090555.full |
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