Association Between Hypertensive Disorders of Pregnancy and Neurodevelopmental Outcomes Among Offspring.
Association Between Hypertensive Disorders of Pregnancy and Neurodevelopmental Outcomes Among Offspring.
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DOI：
10.1001/jamapediatrics.2020.6856
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发表时间：
2021-06-01
期刊：
影响因子：
26.1
通讯作者：
Montgomery S
中科院分区：
文献类型：
--
作者：
Brand JS;Lawlor DA;Larsson H;Montgomery S
妊娠期高血压疾病（HDP）与后代较差的神经发育结局是否独立于共同的家族混杂因素？在这项队列研究中，妊娠并发hdp的后代患自闭症谱系障碍（asd）、注意力缺陷/多动障碍（ADHD）和智力残疾（ID）的几率略高，整体认知能力略低。比较兄弟姐妹的分析具有较小的统计效力，并表明与asd和可能仅ADHD有相似程度的关联。这项研究表明，HDP与后代患asd和ADHD的风险适度增加有关，而与ID和认知表现的关联可能是由共同的家族特征混淆的结果。妊娠期高血压疾病（HDP）与后代较差的神经发育结果相关，但家族混杂因素在这些关联中的作用尚不清楚。研究母亲HDP与后代患自闭症谱系障碍（asd）、注意缺陷/多动障碍（ADHD）和智力残疾（ID）风险的关系，以及后代整体认知表现的变化。这项基于瑞典登记的研究使用了来自出生队列的数据，这些数据分为1987年至1996年出生的1085 024人，并随访至2014年12月31日，以及1982年至1992年出生的285 901名参加征兵评估的男性，包括认知功能测试。统计分析时间为2019年4月1日至2020年6月1日。HDP的诊断，由医疗出生登记处提供。asd、ADHD和ID的诊断从国家患者登记册中提取。认知功能通过笔试进行评估，并总结为单一的9分分数。进行了全队列和兄弟姐妹内分析；后者解释了兄弟姐妹共有的未测量的家族混杂因素。该研究包括1987年至1996年出生的1 085 024人（556 912名男性参与者[51.3%]）和1982年至1992年出生的285 901名参加征兵评估的男性。1987-1996年出生队列产妇HDP患病率为4.0% (n = 42 980)，征兵队列产妇HDP患病率为5.1% （n = 14 515）。共有15858名参与者被诊断为ASD， 36852名参与者被诊断为ADHD， 8454名参与者被诊断为ID。在征兵队列中，男性的平均（SD）认知得分为5.1（1.9）。在多变量调整的全队列分析中，HDP与后代asd（风险比[HR]， 1.22; 95% CI, 1.13-1.31）、ADHD（风险比[HR]， 1.10; 95% CI, 1.05-1.16）和ID（风险比，1.39;95% CI, 1.27-1.53）相关。比较兄弟姐妹HDP不一致的分析在统计学上不太有效，但表明asd（比差，1.19;95% CI, 1.00-1.42）和可能的ADHD（比差，1.09;95% CI, 0.95-1.24）的估计程度相似，但ID（比差，1.04;95% CI, 0.83-1.29）的估计程度相似。在全队列分析中，妊娠高血压疾病与较低的认知评分相关（暴露与未暴露的后代的平均差异为- 0.10;95% CI, - 0.13至- 0.07），但在兄弟姐妹内分析中，这种关联为零（平均差异为0.00;95% CI, - 0.09至0.08）。研究结果表明，HDP与后代患asd和ADHD的风险增加有关，而与ID和认知表现的关系可能被共同的家族（环境或遗传）因素所混淆。本队列研究调查了妊娠期孕妇高血压疾病与后代患自闭症谱系障碍、注意力缺陷/多动障碍和智力残疾风险的关系，以及后代整体认知表现的变化。
Are hypertensive disorders of pregnancy (HDP) associated with poorer neurodevelopmental outcomes in offspring independently of shared familial confounding factors? In this cohort study, offspring of HDP-complicated pregnancies had a somewhat higher incidence of autism spectrum disorders (ASDs), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability (ID) and slightly lower overall cognitive performance. Analyses comparing siblings had less statistical power and indicated associations of a similar magnitude with ASDs and possibly ADHD only. This study suggests that HDP are associated with modestly increased risks of ASDs and possibly ADHD in offspring, whereas associations with ID and cognitive performance are likely the result of confounding by shared familial characteristics. Hypertensive disorders of pregnancy (HDP) have been associated with poorer neurodevelopmental outcomes in offspring, but the role of familial confounding in these associations is unclear. To investigate associations of maternal HDP with risks in offspring of autism spectrum disorders (ASDs), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability (ID), as well as variation in overall cognitive performance in offspring. This Swedish register-based study used data from a birth cohort divided into 1 085 024 individuals born between 1987 and 1996 and followed up until December 31, 2014, and 285 901 men born between 1982 and 1992 who attended assessments for military conscription, including a cognitive function test. Statistical analysis was performed from April 1, 2019, to June 1, 2020. Diagnoses of HDP, which were provided by the Medical Birth Register. Diagnoses of ASDs, ADHD, and ID were extracted from the National Patient Register. Cognitive function was assessed using written tests and summarized as a single 9-point score. Whole-cohort and within-sibship analyses were performed; the latter accounted for unmeasured familial confounding factors shared by siblings. The study included 1 085 024 individuals (556 912 male participants [51.3%]) born between 1987 and 1996 and 285 901 men born between 1982 and 1992 who attended assessments for military conscription. The prevalence of maternal HDP was 4.0% in the 1987-1996 birth cohort (n = 42 980) and 5.1% in the military conscription cohort (n = 14 515). A total of 15 858 participants received a diagnosis of ASD, 36 852 received a diagnosis of ADHD, and 8454 received a diagnosis of ID. The mean (SD) cognitive score among the men in the conscription cohort was 5.1 (1.9). In whole-cohort analyses with multivariable adjustment, HDP were associated with offspring ASDs (hazard ratio [HR], 1.22; 95% CI, 1.13-1.31), ADHD (HR, 1.10; 95% CI, 1.05-1.16), and ID (HR, 1.39; 95% CI, 1.27-1.53). Analyses comparing siblings discordant for HDP were less statistically powered but indicated estimates of similar magnitude for ASDs (HR, 1.19; 95% CI, 1.00-1.42) and possibly ADHD (HR, 1.09; 95% CI, 0.95-1.24), but not for ID (HR, 1.04; 95% CI, 0.83-1.29). Hypertensive disorders of pregnancy were associated with somewhat lower cognitive scores in whole-cohort analysis (mean difference comparing offspring exposed with those unexposed, −0.10; 95% CI, −0.13 to −0.07), but in within-sibship analysis, the association was null (mean difference, 0.00; 95% CI, −0.09 to 0.08). The study results suggest that HDP are associated with small increased risks of ASDs and possibly ADHD in offspring, whereas associations with ID and cognitive performance are likely confounded by shared familial (environmental or genetic) factors. This cohort study investigates associations of maternal hypertensive disorders of pregnancy with risks in offspring of autism spectrum disorders, attention-deficit/hyperactivity disorder, and intellectual disability, as well as variation in overall cognitive performance in offspring.
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