Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Offspring of mothers with alopecia areata had a significantly higher risk of autoimmune, inflammatory, atopic, thyroid, ad psychiatric disorders.

2. Clinicians and mothers with AA should be aware of potential offspring health risks and comorbidities.

Evidence Rating Level: 2 (Good)

Study Rundown:

Alopecia areata (AA) is a chronic autoimmune dermatological condition that results in nonscarring hair loss. Although the exact mechanism is not clear, AA is thought to be related to immune dysregulation affecting hair follicles. Genetic alterations are involved in autoimmunity and immune dysregulation. Therefore this retrospective study investigated whether the presence of material AA was correlated to offspring having an increased risk of comorbidities. To determine increased risk, autoimmune, inflammatory, atopic, thyroid, and psychiatric outcomes of offspring born to mothers with AA were investigated. Maternal AA significantly increased the risk of the following disorders in offspring: AA, alopecia totalis/universalis (AT/AU), vitiligo, atopic disorders, hypothyroidism, and psychiatric disorders. Offspring of mothers with AT/AU were at an increased risk for developing AT/AU and psychiatric disorders. This study has limited generalizability as the study population was of one ethnicity. Furthermore, some disorders (e.g. thyroid disorders) take a long time to occur and thus may have presented outside the study timeline. Other potential limitations include misclassification due to healthcare claims data, the lack of paternal information, and the lack of data on patients’ social determinants of health (e.g., access to medical availability). Lastly, mothers with AA may be more vigilant about their children’s health due to their own health conditions and experience. Strengths of this study include the large reliable databases and subgroup analyses for various demographic and maternal factors.

In-Depth [retrospective cohort]:

The Korean National Institute for Bioethics Policy approved this retrospective population-based birth cohort study. To conduct the study, data was collected from two national databases: the National Health Insurance Service database of Korea and birth registration. There were 3,458,998 mothers and 5,142,008 newborns identified between 2003 and 2015. The definition of offspring born to mothers with AA for this study was offspring born to mothers with 3 or more clinic visits for a primary diagnosis of AA based on ICD-10 code L63. The offspring were then matched 1:10 for birth year, sex, income, insurance, and residence location with offspring born to mothers without a primary or adjuvant diagnosis of AA. In total, 67,364 offspring born to 46,352 mothers with AA were matched to 673,640 unaffected offspring born to 454,085 unaffected mothers. In total, there were more male participants (51.8%) than females, and the mean (SD) maternal age was higher in the offspring born to mothers with AA (31.2 [4.0] vs 30.9 [4.1] years, P < .001). The identified offspring were then observed from birth to December 2020. The primary objective was to investigate the risks for autoimmune, inflammatory, atopic, thyroid, and psychiatric outcomes of the identified offspring born to mothers with AA. Incidences of the following pre-defined diseases were identified within the study population: AA, patchy alopecia (PA), AT/AU, vitiligo, psoriasis, inflammatory bowel disease, rheumatoid arthritis, atopic dermatitis, allergic rhinitis, asthma, hyperthyroidism, hypothyroidism, Graves disease, Hashimoto thyroiditis, attention-deficit hyperactivity disorder, mood disorders (unipolar/bipolar/depressive/and other mood disorder), and anxiety disorder. An occurrence of disease was defined as a minimum of 3 clinic visits for the disease. Furthermore, multivariable Cox proportional hazard analyses were completed for nine covariates: (1) birth year, (2) age, (3) insurance type, (4) income level, (5) residence location, (6) maternal age, (7) mode of delivery, (8) maternal history of atopic disorders, and (9) autoimmune disorders. The following disorders were significantly increased in offspring born to mothers with AA: 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). 5,088 offspring of the mothers with AT/AU were at an increased risk for developing AT/AU (aHR, 2.98; 95% CI, 1.48-6.00) and psychiatric disorders (aHR, 1.27; 95% CI, 1.12-1.44). Overall, maternal AA was associated with offspring development of autoimmune/inflammatory, atopic, thyroid, and psychiatric disorders.

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