Maternal autoimmune diseases and the risk of tics and Tourette's disorder in offspring: insights from Taiwan's real-world data

BackgroundCurrently, tics and Tourette's disorder are burdensome neurological disorders that manifest in vocal and motor tics with onset during childhood. Previous studies have demonstrated that maternal autoimmune diseases may cause several neurodevelopmental disorders in offspring via materna...

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Main Authors: Yi-Feng Lee, Meng-Che Wu, Yen-Chu Huang, Jing-Yang Huang, James Cheng-Chung Wei
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-03-01
Series:Frontiers in Pediatrics
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Online Access:https://www.frontiersin.org/articles/10.3389/fped.2025.1440366/full
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author Yi-Feng Lee
Yi-Feng Lee
Meng-Che Wu
Meng-Che Wu
Meng-Che Wu
Yen-Chu Huang
Yen-Chu Huang
Jing-Yang Huang
Jing-Yang Huang
James Cheng-Chung Wei
James Cheng-Chung Wei
author_facet Yi-Feng Lee
Yi-Feng Lee
Meng-Che Wu
Meng-Che Wu
Meng-Che Wu
Yen-Chu Huang
Yen-Chu Huang
Jing-Yang Huang
Jing-Yang Huang
James Cheng-Chung Wei
James Cheng-Chung Wei
author_sort Yi-Feng Lee
collection DOAJ
description BackgroundCurrently, tics and Tourette's disorder are burdensome neurological disorders that manifest in vocal and motor tics with onset during childhood. Previous studies have demonstrated that maternal autoimmune diseases may cause several neurodevelopmental disorders in offspring via maternal immune activation. However, the association between them has never been thoroughly researched. Thus, in this study, we aimed to explore whether maternal autoimmune diseases are associated with the risk of tics and Tourette's disorder in offspring in a real-world nationwide population-based cohort study.MethodsWe analyzed offspring with or without autoimmune disease exposure between 2009 and 2016 from national population databases in Taiwan. Multivariate analysis, multiple Cox regression analyses, and stratified analyses were conducted in the study.ResultsIn total, 76,411 offspring with autoimmune disease exposure and 1,211,936 offspring without maternal autoimmune disease exposure were selected and analyzed in this study. The incidence of childhood tics and Tourette's disorder was 2.35 [95% confidence interval (CI) 2.23–4.86] and 1.89 (95% CI 1.86–1.92) per 10,000 person-months in children exposed to maternal autoimmune disease and non-exposed children, respectively. The children whose mothers had an autoimmune disease had a 1.26-fold risk of tics and Tourette's disorder compared to children whose mothers did not have an autoimmune disease [crude hazard ratio: 1.26; 95% CI, 1.20–1.34, adjusted hazard ratio (aHR): 1.22; 95% CI, 1.15–1.29]. Offspring of mothers with rheumatoid arthritis (aHR: 1.46, 95% CI, 1.07–1.97), system lupus erythematosus (aHR: 1.57, 95% CI, 1.18–2.09), Sjogren's syndrome (aHR: 1.28, 95% CI, 1.09–1.50), ankylosing spondylitis (aHR: 1.49, 95% CI, 1.07–2.09), Graves’ disease (aHR: 1.26, 95% CI, 1.15–1.37), Hashimoto's thyroiditis (aHR: 1.59, 95% CI, 1.29–1.98), and type I diabetes (aHR: 1.68, 95% CI, 1.13–2.50) had a significantly higher risk of developing tics and Tourette's disorder. Aside from maternal autoimmune diseases, mothers with urinary tract infections, diabetes mellitus, hyperlipidemia, anemia, a sleep disorder, endometriosis, and depression were also associated with childhood tics and Tourette's disorder.ConclusionMaternal autoimmune diseases appeared to be associated with tics and Tourette's disorder in offspring, especially in mothers with the abovementioned diseases. Further research is warranted to investigate the possible pathogenetic mechanisms of these associations.
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spelling doaj-art-6b954fb5254d43da987035e2a0d741cb2025-08-20T03:16:28ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-03-011310.3389/fped.2025.14403661440366Maternal autoimmune diseases and the risk of tics and Tourette's disorder in offspring: insights from Taiwan's real-world dataYi-Feng Lee0Yi-Feng Lee1Meng-Che Wu2Meng-Che Wu3Meng-Che Wu4Yen-Chu Huang5Yen-Chu Huang6Jing-Yang Huang7Jing-Yang Huang8James Cheng-Chung Wei9James Cheng-Chung Wei10Division of Neonatology, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, TaiwanSchool of Medicine, Chung Shan Medical University, Taichung, TaiwanSchool of Medicine, Chung Shan Medical University, Taichung, TaiwanDivision of Pediatric Gastroenterology, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, TaiwanDepartment of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, TaiwanDivision of Pediatric Gastroenterology, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, TaiwanDepartment of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, TaiwanCenter for Health Data Science, Chung Shan Medical University Hospital, Taichung, TaiwanInstitute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, TaiwanDivision of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, TaiwanGraduate Institute of Integrated Medicine, China Medical University, Taichung, TaiwanBackgroundCurrently, tics and Tourette's disorder are burdensome neurological disorders that manifest in vocal and motor tics with onset during childhood. Previous studies have demonstrated that maternal autoimmune diseases may cause several neurodevelopmental disorders in offspring via maternal immune activation. However, the association between them has never been thoroughly researched. Thus, in this study, we aimed to explore whether maternal autoimmune diseases are associated with the risk of tics and Tourette's disorder in offspring in a real-world nationwide population-based cohort study.MethodsWe analyzed offspring with or without autoimmune disease exposure between 2009 and 2016 from national population databases in Taiwan. Multivariate analysis, multiple Cox regression analyses, and stratified analyses were conducted in the study.ResultsIn total, 76,411 offspring with autoimmune disease exposure and 1,211,936 offspring without maternal autoimmune disease exposure were selected and analyzed in this study. The incidence of childhood tics and Tourette's disorder was 2.35 [95% confidence interval (CI) 2.23–4.86] and 1.89 (95% CI 1.86–1.92) per 10,000 person-months in children exposed to maternal autoimmune disease and non-exposed children, respectively. The children whose mothers had an autoimmune disease had a 1.26-fold risk of tics and Tourette's disorder compared to children whose mothers did not have an autoimmune disease [crude hazard ratio: 1.26; 95% CI, 1.20–1.34, adjusted hazard ratio (aHR): 1.22; 95% CI, 1.15–1.29]. Offspring of mothers with rheumatoid arthritis (aHR: 1.46, 95% CI, 1.07–1.97), system lupus erythematosus (aHR: 1.57, 95% CI, 1.18–2.09), Sjogren's syndrome (aHR: 1.28, 95% CI, 1.09–1.50), ankylosing spondylitis (aHR: 1.49, 95% CI, 1.07–2.09), Graves’ disease (aHR: 1.26, 95% CI, 1.15–1.37), Hashimoto's thyroiditis (aHR: 1.59, 95% CI, 1.29–1.98), and type I diabetes (aHR: 1.68, 95% CI, 1.13–2.50) had a significantly higher risk of developing tics and Tourette's disorder. Aside from maternal autoimmune diseases, mothers with urinary tract infections, diabetes mellitus, hyperlipidemia, anemia, a sleep disorder, endometriosis, and depression were also associated with childhood tics and Tourette's disorder.ConclusionMaternal autoimmune diseases appeared to be associated with tics and Tourette's disorder in offspring, especially in mothers with the abovementioned diseases. Further research is warranted to investigate the possible pathogenetic mechanisms of these associations.https://www.frontiersin.org/articles/10.3389/fped.2025.1440366/fullmaternal autoimmune diseasesmaternal immune activationtics and Tourette's disordermaternal and child health databaseTaiwan NHIRD
spellingShingle Yi-Feng Lee
Yi-Feng Lee
Meng-Che Wu
Meng-Che Wu
Meng-Che Wu
Yen-Chu Huang
Yen-Chu Huang
Jing-Yang Huang
Jing-Yang Huang
James Cheng-Chung Wei
James Cheng-Chung Wei
Maternal autoimmune diseases and the risk of tics and Tourette's disorder in offspring: insights from Taiwan's real-world data
Frontiers in Pediatrics
maternal autoimmune diseases
maternal immune activation
tics and Tourette's disorder
maternal and child health database
Taiwan NHIRD
title Maternal autoimmune diseases and the risk of tics and Tourette's disorder in offspring: insights from Taiwan's real-world data
title_full Maternal autoimmune diseases and the risk of tics and Tourette's disorder in offspring: insights from Taiwan's real-world data
title_fullStr Maternal autoimmune diseases and the risk of tics and Tourette's disorder in offspring: insights from Taiwan's real-world data
title_full_unstemmed Maternal autoimmune diseases and the risk of tics and Tourette's disorder in offspring: insights from Taiwan's real-world data
title_short Maternal autoimmune diseases and the risk of tics and Tourette's disorder in offspring: insights from Taiwan's real-world data
title_sort maternal autoimmune diseases and the risk of tics and tourette s disorder in offspring insights from taiwan s real world data
topic maternal autoimmune diseases
maternal immune activation
tics and Tourette's disorder
maternal and child health database
Taiwan NHIRD
url https://www.frontiersin.org/articles/10.3389/fped.2025.1440366/full
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