Older maternal age linked to adverse outcomes in Kawasaki disease
A maternal age of 32 years or older is significantly associated with adverse pregnancy outcomes, including the formation of coronary artery lesions, and in cases of a maternal age of 35 years of older, IV immunoglobulin resistance, among offspring with Kawasaki disease, according to data published in Pediatric Rheumatology.
“In the past three decades, the mean maternal age of giving birth is increasing in many countries, especially in developed countries and Taiwan,” Wei-Dong Huang, of Bao’an Maternal and Child Health Hospital, Jinan University, in Shenzhen, China, and colleagues wrote. “In particular, various studies have reported that advanced maternal age (defined as 35years old or more) is associated with many adverse pregnancy outcomes.”
“Taken together, perinatal factors may influence health outcomes in offspring,” they added. “Identifying the groups vulnerable to developing coronary artery lesions and having [IV immunoglobulin (IVIG)] resistance in [Kawasaki disease (KD)] is important and more precise individualized medicine could be provided.”
To analyze the perinatal factors and clinical outcomes in Kawasaki disease, Huang and colleagues conducted a retrospective cohort study of patients and caregivers at Kaohsiung Chang Gung Memorial Hospital in Taiwan. The study included 185 patient-caregiver pairs, diagnosed Kawasaki disease and followed between January 2014 and December 2017. Caregivers completed a questionnaire with two categories — children’s characteristics and caregivers’ characteristics.
Children’s characteristics included age at disease onset, gender, gestational age at delivery, birth body weight, delivery methods and breastfeeding status. Caregivers’ characteristics included whether they were the parent, education levels, maternal age at giving birth, total number of offspring and family income. The researchers then analyzed the links between these factors and intravenous immunoglobulin treat response and the formation of coronary artery lesions.
According to the researchers, children with Kawasaki disease and coronary artery lesions (CAL) had mothers who were older at birth, compared with those without lesions (P = .016). Specifically, mothers aged 32 years and older demonstrated a higher rate of children with Kawasaki disease with coronary artery lesions (OR = 1.935; 95% CI, 1.007-3.718) compared with those who were younger. In addition, mothers who were aged 35 years and older demonstrated a higher rate of children with Kawasaki disease who were resistant to intravenous immunoglobulin (OR = 4.4; 95% CI, 1.309-14.786).
The researchers found no significant difference in either lesion formation or intravenous immunoglobulin resistance among patients related to age of disease onset, gestational age, birth body weight, delivery methods, breastfeeding, caregiver type, caregivers’ education level, total number of offspring or family income.
“This study was the first to report that increasing maternal age has a significant association with CAL formation and IVIG resistance in KD,” Huang and colleagues wrote. “The exact mechanisms mediating the effect of increasing maternal age and the difference in the maternal age cut-off on the risk for CAL formation and IVIG resistance in subsequent KD observed in our study remains unclear.”
“More studies with larger number of patients are needed to corroborate these findings,” the researchers added. “KD patients with advanced maternal age are in high risk in CAL formation and IVIG resistance; therefore, more aggressive therapies or examination arrangement may be needed for these patients.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.