孕期维生素 D 与儿童注意缺陷多动障碍样症状。
Vitamin D in Pregnancy and Attention Deficit Hyperactivity Disorder-like Symptoms in Childhood.
机构信息
From the aCentre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain; bVirgen de la Arrixaca Universtiy Hospital, IMIB-Arrixaca Research Institute, Murcia, Spain; cCIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; dHospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; eUniversitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain; fIB-SALUT, Area de Salut de Menorca, Balearic Islands, Spain; gUniversity of Valencia, Valencia, Spain; hCenter for Public Health Research (CSISP-FISABIO), Valencia, Spain; iDepartment of Basic Psychological Processes and Their Development, Basque Country University UPV/EHU, San Sebastian, Spain; jBiodonostia Institute, San Sebastian, Gipuzkoa, Spain; kPublic Health Laboratory, Basque Government, Bilbao, Spain; lHospital San Agustín, Avilés, Asturias, Spain; and mUniversity of Oviedo, Asturias, Spain.
出版信息
Epidemiology. 2015 Jul;26(4):458-65. doi: 10.1097/EDE.0000000000000292.
BACKGROUND
Vitamin D status during prenatal brain development may influence risk of attention deficit and hyperactivity disorder (ADHD) symptoms in childhood. However, there are no prospective studies addressing this hypothesis. We aimed to examine whether maternal vitamin D status in pregnancy is associated with risk of ADHD-like symptoms in offspring.
METHODS
We conducted a prospective study analyzing data from 1,650 mother-child pairs from five birth cohorts embedded in the INMA Project (Spain, 1997-2008). Maternal vitamin D status in pregnancy was estimated by measuring plasma concentration of 25-hydroxyvitamin D3 [25(OH)D3] at 13 weeks of gestation. Children were assessed by teachers for ADHD-like symptoms at ages 4-5 years using the Diagnostic and Statistical Manual of Mental Disorders ADHD form list.
RESULTS
After adjustment, the number of total ADHD-like symptoms in children decreased by 11% per 10 ng/ml increment of maternal 25(OH)D3 concentration (incidence rate ratio [IRR] = 0.89; 95% confidence interval [CI] = 0.80, 0.98). Similarly, the number of symptoms in the ADHD subscales decreased in relation to higher maternal 25(OH)D3 concentration (IRR per 10 ng/ml increment = 0.89; 95% CI = 0.79, 0.99 for the inattention scale; and IRR = 0.88; 95% CI = 0.78, 0.99 for the hyperactivity-impulsivity scale). Using diagnostic criteria, we found an association of increasing maternal 25(OH)D3 with a lower risk of ADHD DSM-IV (relative risk ratio per 10 ng/ml increment = 0.87; 95% CI = 0.72, 1.06) and ICD-10 hyperkinetic disorder (relative risk ratio = 0.72; 95% CI = 0.49, 1.04) in children.
CONCLUSION
Higher maternal circulating levels of 25(OH)D3 in pregnancy are associated with lower risk of developing ADHD-like symptoms in childhood.
背景
胎儿大脑发育过程中的维生素 D 状况可能会影响儿童时期注意力缺陷多动障碍（ADHD）症状的风险。然而，目前还没有前瞻性研究来验证这一假说。我们旨在研究孕妇维生素 D 状况是否与后代出现类似 ADHD 的症状有关。
方法
我们进行了一项前瞻性研究，分析了来自五个 INMA 项目（西班牙，1997-2008 年）的 1650 对母婴对的数据。通过测量妊娠 13 周时血浆中 25-羟维生素 D3 [25(OH)D3]的浓度来评估孕妇妊娠期间的维生素 D 状况。在 4-5 岁时，由教师根据《精神障碍诊断与统计手册》ADHD 形式清单评估儿童的 ADHD 样症状。
结果
调整后，儿童 ADHD 样症状总数每增加 10ng/ml 母体 25(OH)D3 浓度，下降 11%（发病率比 [IRR] = 0.89；95%置信区间 [CI] = 0.80，0.98）。同样，与较高的母体 25(OH)D3 浓度相关，ADHD 亚量表的症状数量也有所减少（每增加 10ng/ml 的 IRR = 0.89；95%CI = 0.79，0.99 为注意力不集中量表；IRR = 0.88；95%CI = 0.78，0.99 为多动冲动量表）。使用诊断标准，我们发现母体 25(OH)D3 增加与 ADHD DSM-IV（每增加 10ng/ml 的相对风险比 = 0.87；95%CI = 0.72，1.06）和 ICD-10 多动障碍（相对风险比 = 0.72；95%CI = 0.49，1.04）的风险降低有关。
结论
孕妇妊娠期间循环 25(OH)D3 水平较高与儿童时期出现类似 ADHD 的症状风险降低有关。
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