Are prematurity and environmental factors determinants for developing childhood-onset systemic lupus erythematosus?

• Published in: Modern rheumatology Vol. 28; no. 1; pp. 156 - 160
• Main Authors: Conde, Paola G., Farhat, Luis C., Braga, Alfésio L. F., Sallum, Adriana E. M., Farhat, Sylvia C. L., Silva, Clovis A.
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 02.01.2018
• Subjects: Adult; Air Pollutants - adverse effects; air pollution; Carbon Monoxide - adverse effects; Case-Control Studies; Child; Childhood-onset systemic lupus erythematosus; environmental factor; Female; Humans; Infant, Newborn; Infant, Premature; Lupus Erythematosus, Systemic - etiology; Male; Maternal Exposure - adverse effects; maternal occupational exposure; Particulate Matter - adverse effects; Pregnancy; Risk Factors; smoking; Smoking - adverse effects; maternal occupational exposure; air pollution; environmental factor; smoking; Childhood-onset systemic lupus erythematosus
• ISSN: 1439-7595; 1439-7609
• DOI: 10.1080/14397595.2017.1332508

Objective: The objective of this study is to evaluate the influence of exposure to air pollutants and inhalable environmental elements during pregnancy and after birth until childhood-onset systemic lupus erythematosus(cSLE) diagnosis. Methods: This case-control study comprised 30 cSLE patients and 86 healthy controls living in the Sao Paulo metropolitan area. A structured and reliable questionnaire (kappa index for test-retest was 0.78) assessed demographic data, gestational and perinatal-related-factors, and exposure to inhalable elements during pregnancy and after birth (occupational exposure to inhalable particles and/or volatile vapor, and/or tobacco, as well as, the presence of industrial activities or gas stations near the home/work/daycare/school). Tropospheric pollutants included: particulate matter (PM 10 ), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), ozone (O 3 ) and carbon monoxide (CO). Results: The median current age was similar between cSLE patients and healthy controls [16.0 (5-21) versus 15.0 (4-21) years, p = .32], likewise the frequency of female gender (87% versus 78%, p = .43). The frequencies of prematurity (30% versus 6%, p = .001), maternal occupational exposure during pregnancy (59% versus 12%, p < .001), exposure to volatile vapor (48% versus 8%, p < .001) and fetal smoking (maternal and/or secondhand) (37% versus 19%, p = .008) were significantly higher in cSLE patients compared with controls. In a multivariate analysis regarding the gestation period, maternal occupational exposure (OR 13.5, 95% CI 2.5-72.4, p = .002), fetal smoking (OR 8.6, 95%CI 1.6-47, p = .013) and prematurity (OR 15.8, 95%CI 1.9-135.3, p = .012) remained risk factors for cSLE development. Furthermore, exposure to secondhand smoking during pregnancy and after birth (OR 9.1, 95%CI 1.8-42.1, p = .002) was also a risk factor for cSLE development. Conclusions: Prematurity and environmental factors were risk factors for developing cSLE.