先存的母体心血管疾病与后代神经发育障碍的关联：瑞典和加拿大不列颠哥伦比亚省的队列研究。

Association of pre-existing maternal cardiovascular diseases with neurodevelopmental disorders in offspring: a cohort study in Sweden and British Columbia, Canada.

机构信息

Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.

出版信息

Int J Epidemiol. 2024 Feb 1;53(1). doi: 10.1093/ije/dyad184.

DOI:10.1093/ije/dyad184

PMID:38150596

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10859157/

Abstract

BACKGROUND

We aimed to investigate the associations of pre-existing maternal cardiovascular disease (CVD) with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) in offspring.

METHODS

This population-based cohort study included singletons live-born without major malformations in Sweden (n = 2 699 675) and British Columbia (BC), Canada (n = 887 582) during 1990-2019, with follow-up from age 1 year until the outcome, death, emigration or December 2020, whichever came first. The primary exposure was defined as a composite CVD diagnosed prior to conception: cerebrovascular disease, arrhythmia, heart failure, valvular and congenital heart diseases. The incidences of ADHD, ASD and ID, comparing offspring of mothers with versus without CVD, were calculated as adjusted hazard ratios (aHRs). These results were compared with models using paternal CVD as negative control exposure.

RESULTS

Compared with offspring of mothers without CVD, offspring of mothers with CVD had 1.15-fold higher aHRs of ADHD [95% confidence interval (CI): 1.10-1.20] and ASD (95% CI 1.07-1.22). No association was found between maternal CVD and ID. Stratification by maternal CVD subtypes showed increased hazards of ADHD for maternal heart failure (HR 1.31, 95% CI 1.02-1.61), cerebrovascular disease (HR 1.20, 95% CI 1.08-1.32), congenital heart disease (HR 1.18, 95% CI 1.08-1.27), arrhythmia (HR 1.13, 95% CI 1.08-1.19) and valvular heart disease (HR 1.12, 95% CI 1.00-1.24). Increased hazards of ASD were observed for maternal cerebrovascular disease (HR 1.25, 95% CI 1.04-1.46), congenital heart disease (HR 1.17, 95% CI 1.01-1.33) and arrythmia (HR 1.12, 95% CI 1.01-1.21). Paternal CVD did not show associations with ADHD, ASD or ID, except for cerebrovascular disease which showed associations with ADHD and ASD.

CONCLUSIONS

In this large cohort study, pre-existing maternal CVD was associated with increased risk of ADHD and ASD in offspring.

摘要

背景

本研究旨在探讨母亲在妊娠前存在心血管疾病（CVD）与后代注意缺陷多动障碍（ADHD）、自闭症谱系障碍（ASD）和智力障碍（ID）之间的关联。

方法

本基于人群的队列研究纳入了 1990 年至 2019 年期间在瑞典（n=2699675）和加拿大不列颠哥伦比亚省（BC）出生且无重大畸形的单胎活产儿，随访至 1 岁，直至出现结局、死亡、移民或 2020 年 12 月（以先发生者为准）。主要暴露因素定义为妊娠前诊断的复合 CVD：脑血管疾病、心律失常、心力衰竭、瓣膜和先天性心脏病。计算患有 CVD 的母亲与无 CVD 的母亲的后代的 ADHD、ASD 和 ID 的发病率，并计算调整后的危险比（aHR）。将这些结果与以父亲 CVD 为阴性对照暴露的模型进行了比较。

结果

与无 CVD 母亲的后代相比，CVD 母亲的后代患 ADHD 的 aHR 为 1.15 倍（95%CI：1.10-1.20），ASD 的 aHR 为 1.07-1.22。母亲 CVD 与 ID 之间无关联。亚组分析显示，母亲心力衰竭（HR 1.31，95%CI 1.02-1.61）、脑血管疾病（HR 1.20，95%CI 1.08-1.32）、先天性心脏病（HR 1.18，95%CI 1.08-1.27）、心律失常（HR 1.13，95%CI 1.08-1.19）和瓣膜性心脏病（HR 1.12，95%CI 1.00-1.24）与 ADHD 的发生风险增加有关。母亲脑血管疾病（HR 1.25，95%CI 1.04-1.46）、先天性心脏病（HR 1.17，95%CI 1.01-1.33）和心律失常（HR 1.12，95%CI 1.01-1.21）与 ASD 的发生风险增加有关。父亲 CVD 与 ADHD、ASD 或 ID 无关联，但脑血管疾病与 ADHD 和 ASD 相关。