孕妇的碘营养状况与儿童注意缺陷多动障碍或自闭症特征无一致性关联。
Maternal Iodine Status During Pregnancy Is Not Consistently Associated with Attention-Deficit Hyperactivity Disorder or Autistic Traits in Children.
机构信息
The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, Netherlands.
Department of Internal Medicine, Academic Center For Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, Netherlands.
出版信息
J Nutr. 2020 Jun 1;150(6):1516-1528. doi: 10.1093/jn/nxaa051.
BACKGROUND
Severe iodine deficiency during pregnancy can cause intellectual disability, presumably through inadequate placental transfer of maternal thyroid hormone to the fetus. The association between mild-to-moderate iodine deficiency and child neurodevelopmental problems is not well understood.
OBJECTIVES
We investigated the association of maternal iodine status during pregnancy with child attention-deficit hyperactivity disorder (ADHD) and autistic traits.
METHODS
This was a collaborative study of 3 population-based birth cohorts: Generation R (n = 1634), INfancia y Medio Ambiente (n = 1293), and the Avon Longitudinal Study of Parents and Children (n = 2619). Exclusion criteria were multiple fetuses, fertility treatment, thyroid-interfering medication use, and pre-existing thyroid disease. The mean age of assessment in the cohorts was between 4.4 and 7.7 y for ADHD symptoms and 4.5 and 7.6 y for autistic traits. We studied the association of the urinary iodine-to-creatinine ratio (UI/Creat) <150 μg/g-in all mother-child pairs, and in those with a urinary-iodine measurement at ≤18 weeks and ≤14 weeks of gestation-with the risk of ADHD or a high autistic-trait score (≥93rd percentile cutoff), using logistic regression. The cohort-specific effect estimates were combined by random-effects meta-analyses. We also investigated whether UI/Creat modified the associations of maternal free thyroxine (FT4) or thyroid-stimulating hormone concentrations with ADHD or autistic traits.
RESULTS
UI/Creat <150 μg/g was not associated with ADHD (OR: 1.2; 95% CI: 0.7, 2.2; P = 0.56) or with a high autistic-trait score (OR: 0.8; 95% CI: 0.6, 1.1; P = 0.22). UI/Creat <150 μg/g in early pregnancy (i.e., ≤18 weeks or ≤14 weeks of gestation) was not associated with a higher risk of behavioral problems. The association between a higher FT4 and a greater risk of ADHD (OR: 1.3; 95% CI: 1.0, 1.6; P = 0.017) was not modified by iodine status.
CONCLUSIONS
There is no consistent evidence to support an association of mild-to-moderate iodine deficiency during pregnancy with child ADHD or autistic traits.
背景
妊娠期间严重碘缺乏可导致智力障碍，这可能是由于母体甲状腺激素向胎儿的胎盘转运不足所致。轻度至中度碘缺乏与儿童神经发育问题之间的关系尚不清楚。
目的
我们研究了妊娠期间母体碘状况与儿童注意缺陷多动障碍（ADHD）和自闭症特征之间的关系。
方法
这是一项对 3 个人群为基础的出生队列的合作研究：生育队列研究（n=1634）、INfancia y Medio Ambiente（n=1293）和雅芳纵向父母与子女研究（n=2619）。排除标准为多胎妊娠、生育治疗、甲状腺干扰药物使用和预先存在的甲状腺疾病。这些队列的平均评估年龄为 ADHD 症状 4.4 至 7.7 岁和自闭症特征 4.5 至 7.6 岁。我们研究了所有母婴对子中尿碘/肌酐比值（UI/Creat）<150μg/g 以及妊娠 18 周和 14 周时尿碘测量值≤18 周和≤14 周时，与 ADHD 或高自闭症特征评分（≥93 百分位截止值）风险之间的关系，使用逻辑回归。通过随机效应荟萃分析合并队列特异性效应估计值。我们还研究了 UI/Creat 是否改变了母体游离甲状腺素（FT4）或促甲状腺激素浓度与 ADHD 或自闭症特征之间的关系。
结果
UI/Creat <150μg/g 与 ADHD（OR：1.2；95%CI：0.7，2.2；P=0.56）或高自闭症特征评分（OR：0.8；95%CI：0.6，1.1；P=0.22）无关。妊娠早期（即≤18 周或≤14 周）UI/Creat <150μg/g 与行为问题风险增加无关。较高的 FT4 与 ADHD 风险增加之间的关联（OR：1.3；95%CI：1.0，1.6；P=0.017）不受碘状态的影响。
结论
没有一致的证据支持妊娠期间轻度至中度碘缺乏与儿童 ADHD 或自闭症特征之间存在关联。
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