Maternal Autoimmune Diseases and the Risk of Tics & Tourette's in Offspring: Insights from Taiwan's Real-World Data

Yi-Feng Lee ^1,2 Meng-Che Wu ^2,3,4 Yen-Chu Huang ^3,4 Jing Yang Huang ^5,6* James Cheng-Chung Wei ^7,8*

• ¹ Division of Neonatology, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
• ² School of Medicine, Chung Shan Medical University, Taichung, Taiwan
• ³ Division of Gastroenterology, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
• ⁴ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
• ⁵ Center for health data science, Chung Shan Medical University Hospital, Taichung, Taiwan
• ⁶ Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
• ⁷ Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
• ⁸ Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan

Nowadays, tics and Tourette's disorder is a burdensome neurologic disorder that manifests in vocal and motor tics with onset during childhood. Earlier studies have demonstrated that maternal autoimmune disease may cause several neurodevelopmental disorders in offspring via maternal immune activation. However, the association between each other has never been thoroughly researched. Thus, in this study we aimed to explore whether maternal autoimmune disease is associated with the risk of tics and Tourette's disorder in offspring in a real-world nationwide population-based cohort study.We analyzed offspring with or without maternal autoimmune disease between 2009 and 2016 from linking national populational databases in Taiwan. Multivariate analysis, multiple Cox regression analyses, stratified analyses were applied in the study.76411 offsprings with maternal autoimmune disease and 1211936 offsprings without maternal autoimmune disease were selected and analyzed in this study. The incidence of childhood tics and Tourette's disorder was 2.35 (95% CI 2.23-4.86) and 1.89 (95% CI 1.86-1.92) per 10,000 personmonths in children exposed to maternal autoimmune disease and non-exposed children, respectively.The children whose mothers had autoimmune disease had a 1.26-fold risk of tics and Tourette's disorder compared to children whose mothers did not have autoimmune disease (crude hazard ratio: