Objectives Very few investigations have explored the association between CHDs in offspring and mothers with autoimmune disease. In this study, we aimed to explore whether maternal autoimmune disease increases the risk of CHDs in newborns. Methods We analyzed 4780 offspring with maternal autoimmune disease and 9416 offspring without maternal autoimmune disease matching 1:2 with age and sex between 2009 and 2016 from databases including the National Health Insurance program, birth certificate applications, cause of death data, and Maternal and Child Health Database, which is managed by the Health and Welfare Data Science Center (HWDC) in Taiwan. Birth year, birth weight, gestational age, the children’s sex, mode of delivery, congenital defects, urbanization, insurance unit, maternal and paternal comorbidities, child or parents died within one year after birth and medication exposure during pregnancy were selected as covariates for further multivariate analysis. Also, multiple Cox regression analysis was performed to evaluate the adjusted hazard ratio (aHR) of CHDs. Results The incidence of CHDs was 5.35 per 10000 person-months in autoimmune mothers. The result of the multivariate Cox regression showed that the children whose mothers had autoimmune disease had a 1.57-fold risk of CHDs compared to children whose mothers did not have an autoimmune disease (crude hazard ratio: 1.57; 95% CI, 1.29-1.90, aHR: 1.51; 95% CI, 1.24-1.85). Conclusion Maternal autoimmune disease might be a risk factor for developing CHDs in offspring, especially in mothers with systemic lupus erythematosus or Sjogren’s syndrome. Further research is warranted to investigate the possible pathogenesis mechanisms of this association.

Background: Atopic dermatitis (AD) contributes to substantial social and financial costs in public health care systems. Antibiotic exposure during pregnancy has been proposed as a risk factor, but findings remain inconsistent. The aim of this study was to investigate the association between prenatal antibiotic use and childhood AD. Methods: We performed a population-based cohort study using data collected from the Taiwan Maternal and Child Health Database from 2009 to 2016. Associations were determined using Cox proportional hazards model and were adjusted for several potential covariates, including maternal atopic disorders and gestational infections. Subgroup analyses evaluated the influence of postnatal infant antibiotic/acetaminophen use on the association between prenatal antibiotic exposure and childhood AD diagnosed after 1 year of age. Results: A total of 1288343 mother-child pairs were identified and 39.5% received antibiotics prenatally. Maternal antibiotic use during pregnancy was slightly positively associated with childhood AD (aHR 1.05, 95% CI 1.04-1.06), especially in the first and second trimesters. An apparent dose-response pattern was observed with an 11% increased risk when the exposure was ≥5 courses prenatally (aHR 1.11, 95% CI 1.09-1.14). Subgroup analysis showed the positive association remained significant regardless of postnatal antibiotic use; however, a negative association was found in children without postnatal infant acetaminophen use (aHR 1.02, 95% CI 0.97-1.07). Conclusion: Maternal antibiotic use during pregnancy was associated with increased risk of childhood AD in a dose-related manner. Possible confounders existed between prenatal antibiotics and postnatal infant acetaminophen use in the subgroup analysis. Further research may be warranted to investigate this variable using a prospectively designed study, and also to examine whether or not this association is specifically related to pregnancy.