Children of Mothers With Alopecia Areata More Likely to Develop Certain Disorders

In a nationwide population-based birth cohort study in Korea, investigators found that children born to mothers with alopecia areata (AA) had a significantly higher incidence of some autoimmune, inflammatory, atopic, thyroid, and psychiatric disorders.¹

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The retrospective study linked 2 databases, the National Health Insurance Service (NHIS) database of Korea and birth registration. Researchers identified 3,458,998 mothers and 5,142,008 newborns from 2003 to 2015. Of these, 67,364 newborns were born to 46,352 mothers with AA, and 673,640 newborns were born to 454,085 mothers without AA. Newborns born to mothers with 3 or more visits to a clinic for AA were considered to be children of mothers with AA. The International Classification of Diseases, Tenth Revision (ICD-10) code L63 was the standard used to determine presence of AA. Participants were matched based on age, sex, income level, type of insurance, and region.

Newborns were matched to newborns of mothers without AA, and all were followed until death, emigration, or December 2020. Newborns born to mothers with patchy alopecia (PA) or alopecia totalis/universalis (AT/AU) were separated so further analysis based on severity of AA could be performed. The follow-up period ranged from 5 to 17 years, with the median being 11 years.

Maternal AA resulted in a higher risk for autoimmune and inflammatory disorders among their children. “The risk of AA (adjusted hazard ratio [aHR], 2.08; 95% CI, 1.88-2.30), AT/AU (aHR, 1.57; 95% CI, 1.18-2.08), vitiligo (aHR, 1.47; 95% CI, 1.32-1.63), atopic disorders (aHR, 1.07; 95% CI, 1.06-1.09), hypothyroidism (aHR, 1.14; 95% CI, 1.03-1.25), and psychiatric disorders (aHR, 1.15; 95% CI, 1.11-1.20) was significantly increased in offspring born to mothers with AA.”¹ 

In addition, “the risk of hypothyroidism (aHR, 1.14; 95% CI, 1.03-1.25) and psychiatric disorders, including ADHD (aHR, 1.16; 95% CI, 1.10-1.21), mood disorder (aHR, 1.13; 95% CI, 1.07-1.20), and anxiety disorder (aHR, 1.14; 95% CI, 1.07-1.20), were significantly higher.”¹

The risk of AT/AU in children of mothers with AT/AU was significantly higher than in children born to mothers with PA, as was the risk of psychiatric disorders including ADHD, mood disorder, and anxiety disorder. Female children had a higher risk of AA, vitiligo, and psychiatric disorders than males, and children born to mothers over 35 were also at a higher risk of AA, atopic disorders, and psychiatric disorders.

Maternal onset of AA did not affect whether children developed AA, as mothers who developed AA before delivery and those who developed AA after delivery were equally likely to have children who developed AA.

Based on these findings, investigators concluded that clinicians should be alert to the possibility of certain conditions developing in children of mothers with AA.

Reference

1. Lee JY, Ju HJ, Han JH, et al. Autoimmune, inflammatory, atopic, thyroid, and psychiatric outcomes of offspring born to mothers with alopecia areata. JAMA Dermatol. 2023; 159(7):711–719. doi:10.1001/jamadermatol.2023.1261 https://jamanetwork.com/journals/jamadermatology/fullarticle/2805463?guestAccessKey=5c61f3c3-346d-4f88-bc96-d3be4634aad5&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamadermatology&utm_content=etoc&utm_term=072023