Maternal type 1 diabetes, pre-term birth and risk of autism spectrum disorder-a prospective cohort study.
Maternal type 1 diabetes, pre-term birth and risk of autism spectrum disorder-a prospective cohort study.
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DOI：
10.1093/ije/dyac116
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发表时间：
2023-04-19
影响因子：
7.7
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中科院分区：
文献类型：
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有研究表明，母亲患1型糖尿病（T1D）会增加其后代患自闭症谱系障碍（ASD）的风险。然而，目前尚不清楚这种风险是否由早产介导，早产影响约三分之一的T1D妊娠，以及母体糖化血红蛋白（HbA1c）水平是否影响风险。1998年至2015年间出生的140万瑞典儿童及其父母。孕妇在妊娠前或妊娠早期的T1D和HbA1c，妊娠期和ASD诊断均来自瑞典国家登记处。通过Cox回归的风险比（hr）或log-二项回归的RR估计ASD的相对危险度（RR）和95% ci。在146650名儿童中，8003名（0.6%）的母亲患有T1D， 24941名（1.8%）被诊断为ASD， 81515名（5.8%）早产。T1D母亲的后代患ASD的风险增加，HR = 1.40（1.21-1.61）。每增加+5 mmol/mol的HbA1c的RR估计为1.03（0.97-1.10）。早产介导的T1D对ASD的影响估计为RR = 1.06(1.05 ~ 1.08)，占总影响的22%（16% ~ 41%）。妊娠期T1D与后代ASD风险增加有关。总影响的20%是由早产造成的。除了与T1D诊断本身相关的风险外，HbA1c与ASD风险无关。对患有T1D的母亲的后代的ASD的认识可能是有必要的，特别是考虑到早产的额外影响。
It has been suggested that maternal type 1 diabetes (T1D) increases the risk of autism spectrum disorder (ASD) in the offspring. However, it is unclear whether this risk is mediated by pre-term birth, affecting around one-third of pregnancies with T1D, and whether maternal levels of glycated haemoglobin (HbA1c) impact the risk. A cohort of 1.4 million Swedish children born between 1998 and 2015, and their parents. Maternal T1D and HbA1c before or in early pregnancy, gestational and ASD diagnoses were obtained from Swedish national registers. Relative risk (RR) and 95% CIs of ASD were estimated by hazard ratios (HRs) from Cox regression or RR from log-binomial regression. Of 1 406 650 children, 8003 (0.6%) were born to mothers with T1D, 24 941 (1.8%) were diagnosed with ASD and 81 915 (5.8%) were born pre-term. The risk of ASD was increased in offspring of mothers with T1D was HR = 1.40 (1.21–1.61). The RR for each +5-mmol/mol excess HbA1c was estimated at HR = 1.03 (0.97–1.10). The T1D effect on ASD mediated through pre-term birth was estimated at RR = 1.06 (1.05 to 1.08), corresponding to 22% (16% to 41%) of the total effect. T1D in pregnancy was associated with increased ASD risk in the offspring. Twenty percent of the total effect was accounted for by pre-term birth. HbA1c was not associated with ASD risk, beyond the risk associated by the T1D diagnosis itself. Awareness of ASD in the offspring of mothers with T1D may be warranted, especially considering the additional effect of pre-term birth.
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