Department of Foundations of Medicine, NYU-Long Island School of Medicine, Mineola, New York.
Department of Obstetrics and Gynecology, NYU-Winthrop Hospital, Mineola, New York.
Am J Perinatol. 2021 Jan;38(2):191-201. doi: 10.1055/s-0040-1717073. Epub 2020 Oct 21.
This study aimed to determine if hypothyroidism prior to, or during, pregnancy increases the risk of attention-deficit hyperactivity disorder (ADHD) in the child and how the association may be modified by preterm birth, sex of the child, and race-ethnicity.
Data were abstracted from linked maternal-child medical records. Incidence rate differences (IRDs), adjusted hazard ratios (aHRs), and their 95% confidence intervals (CIs) were estimated to evaluate the association of maternal hypothyroidism with childhood ADHD risk. Stratified analyses were used to evaluate whether the association is affected by timing of first diagnosis, gestational age at birth (term vs. preterm), sex, and race-ethnicity.
Hypothyroidism diagnosed prior to (IRD = 1.30), or during (IRD = 0.59) pregnancy increases the risk of ADHD in the children (aHR = 1.27; 95% CI: 1.15, 1.41, and 1.17; 95% CI: 1.00, 1.38). The association was strongest when diagnosed during the first trimester (IRD = 0.97 and aHR = 1.28; 95% CI: 1.04, 1.58). For children born preterm, there was significantly increased risk of ADHD if their mothers were diagnosed prior to (IRD = 3.06 and aHR = 1.43; 95% CI: 1.09, 1.88), but not during pregnancy. The effect of maternal hypothyroidism on increased risk of ADHD was stronger for boys (IRD = 1.84 and aHR = 1.26; 95% CI: 1.14, 1.40) than it was for girls (IRD = 0.48 and aHR = 1.19; 95% CI: 1.01, 1.40) and for Hispanic children (IRD = 1.60 and aHR = 1.45; 95% CI: 1.25, 1.68) compared with other race ethnicities.
Exposure to maternal hypothyroidism during the periconceptual period significantly increases the risk of ADHD and that the association varies with gestational age at delivery, child sex, and race-ethnicity.
· Maternal hypothyroidism increases the risk of ADHD diagnosis in the offspring.. · The association of maternal hypothyroidism with childhood ADHD was influenced by timing of diagnosis.. · Strength of the association was strongest in preterm born infants, boys, and Hispanic children..
本研究旨在确定妊娠前或妊娠期间的甲状腺功能减退症是否会增加儿童注意力缺陷多动障碍（ADHD）的风险，以及早产、儿童性别和种族/民族如何改变这种关联。
从母婴医疗记录中提取数据。采用发病率差异（IRD）、调整后的危害比（aHR）及其 95%置信区间（CI）来评估母体甲状腺功能减退症与儿童 ADHD 风险之间的关联。分层分析用于评估首次诊断的时间、出生时的胎龄（足月与早产）、性别和种族/民族是否会影响这种关联。
妊娠前（IRD=1.30）或妊娠期间（IRD=0.59）诊断出的甲状腺功能减退症会增加儿童患 ADHD 的风险（aHR=1.27；95%CI：1.15，1.41 和 1.17；95%CI：1.00，1.38）。在孕早期诊断时，这种关联最强（IRD=0.97，aHR=1.28；95%CI：1.04，1.58）。对于早产儿，如果母亲在妊娠前被诊断出患有甲状腺功能减退症，则患有 ADHD 的风险显著增加（IRD=3.06，aHR=1.43；95%CI：1.09，1.88），但如果在妊娠期间诊断出甲状腺功能减退症则没有增加。母亲甲状腺功能减退症对 ADHD 风险增加的影响在男孩中（IRD=1.84，aHR=1.26；95%CI：1.14，1.40）比在女孩中（IRD=0.48，aHR=1.19；95%CI：1.01，1.40）和西班牙裔儿童中（IRD=1.60，aHR=1.45；95%CI：1.25，1.68）更强，与其他种族/民族相比。
围孕期暴露于母体甲状腺功能减退症会显著增加儿童患 ADHD 的风险，且这种关联与分娩时的胎龄、儿童性别和种族/民族有关。
