Maternal Autoimmune Diseases and Offspring Structural Congenital Heart Disease: A Nationwide Population-Based Cohort Study.

BACKGROUND: Maternal autoimmune diseases (ADs) are associated with adverse pregnancy outcomes, yet their specific impact on offspring structural congenital heart disease (CHD) remains inconclusive. This study aimed to evaluate the risk of structural CHD in children born to mothers with various ADs using a nationwide population-based database. METHODS: We conducted a nationwide retrospective cohort study using the Maternal and Child Health Database in Taiwan (2004-2019), a comprehensive data set linking the National Health Insurance Research Database with birth registries. We identified 4708 live births from mothers with ADs and matched them 1:2 with 9416 control births. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for structural CHD, adjusting for maternal age, comorbidities, and pregnancy-related factors. RESULTS: Offspring of mothers with ADs had a significantly higher risk of CHD compared with the control group (aHR, 1.51 [95% CI, 1.24-1.85]). Specific maternal ADs significantly associated with offspring CHD included systemic lupus erythematosus (aHR, 2.01 [95% CI, 1.55-2.60]) and Sjögren syndrome (aHR, 1.47 [95% CI, 1.10-1.96]). CONCLUSIONS: Maternal ADs are independent risk factors for offspring structural CHD. These findings underscore the importance of multidisciplinary counseling and specialized fetal echocardiographic screening for pregnant women with ADs to ensure early detection and management of potential cardiac defects in their offspring. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: CS19009.