Werenberg Dreier Julie, Nybo Andersen Anne-Marie, Hvolby Allan, Garne Ester, Kragh Andersen Per, Berg-Beckhoff Gabriele
Institute of Public Health, University of Southern Denmark, Esbjerg, Denmark.
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
J Child Psychol Psychiatry. 2016 Apr;57(4):540-8. doi: 10.1111/jcpp.12480. Epub 2015 Nov 3.
Fever and infections are common events during pregnancy, and have been shown to be associated with neurodevelopmental impairment in the offspring. The evidence in relation to attention deficit/hyperactivity disorder (ADHD) is, however, nonexistent for fever and limited for infections. The aim of this study was therefore to investigate the impact of these exposures on the occurrence of ADHD in the offspring, considering gestational timing as well as intensity of exposure.
The study was conducted within the Danish National Birth Cohort, using data on 89,146 pregnancies enrolled during 1996-2002. Exposure to fever and infections were assessed prospectively in two computer-assisted telephone interviews during pregnancy and ADHD status in the child was determined using registry information from three nation-wide patient and prescription registers. Stratified Cox regressions were used to calculate adjusted hazard ratios of ADHD occurrence.
The analyses revealed no overall association between maternal exposure to fever or infections and ADHD in the offspring [adjusted hazard ratio (aHR): 1.03, 95% confidence interval (CI): 0.93-1.13 and aHR: 1.01, 95% CI: 0.92-1.11]. When the exposures were considered during specific gestational periods, increased rates of ADHD were observed following fever in gestational weeks 9-12 (aHR: 1.33, 95% CI: 1.12-1.58), and genitourinary infections in weeks 33-36 (aHR: 1.60, 95% CI: 1.13-2.26).
Although no overall adverse association between fever and infections in pregnancy and ADHD in the offspring was found, the analyses indicated that exposures during specific time windows of the pregnancy could be associated with increased ADHD occurrence.
发热和感染是孕期常见的情况，且已表明与后代的神经发育障碍有关。然而，关于注意力缺陷/多动障碍（ADHD），发热方面的证据不存在，感染方面的证据有限。因此，本研究的目的是探讨这些暴露因素对后代ADHD发生的影响，同时考虑妊娠时间以及暴露强度。
本研究在丹麦国家出生队列中进行，使用了1996 - 2002年期间登记的89146例妊娠的数据。在孕期的两次计算机辅助电话访谈中前瞻性评估发热和感染的暴露情况，并使用来自三个全国性患者和处方登记处的登记信息确定儿童的ADHD状态。采用分层Cox回归计算ADHD发生的调整风险比。
分析显示，母亲暴露于发热或感染与后代ADHD之间无总体关联[调整风险比（aHR）：1.03，95%置信区间（CI）：0.93 - 1.13；aHR：1.01，95% CI：0.92 - 1.11]。当在特定孕期考虑这些暴露因素时，在妊娠第9 - 12周发热后观察到ADHD发生率增加（aHR：1.33，95% CI：1.12 - 1.58），在第33 - 36周发生泌尿生殖系统感染后也观察到ADHD发生率增加（aHR：1.60，95% CI：1.13 - 2.26）。
尽管未发现孕期发热和感染与后代ADHD之间存在总体不良关联，但分析表明，孕期特定时间窗内的暴露可能与ADHD发生率增加有关。
