Obstetric mode of delivery and attention-deficit/hyperactivity disorder: a sibling-matched study
Obstetric mode of delivery and attention-deficit/hyperactivity disorder: a sibling-matched study
复制标题
DOI：
10.1093/ije/dyw001
复制
发表时间：
2016-04-01
影响因子：
7.7
通讯作者：
Kearney, Patricia M.
中科院分区：
文献类型：
--
作者：
Curran, Eileen A.;Khashan, Ali S.;Kearney, Patricia M.
背景资料：有研究表明，剖腹产（CS）可能会通过微生物群或应激反应的变化影响心理发育。我们评估的影响交付方式，特别是CS，注意力缺陷/多动障碍（ADHD）的发展，使用一个大的，以人口为基础的coherent.Methods：研究队列包括所有单胎活产在瑞典从1990年至2008年使用的数据从瑞典国家登记册。分娩方式包括：无辅助阴道分娩（VD）、辅助VD、择期CS或急诊CS。ADHD是使用国际疾病分类第10版（F90或F98.8）或ADHD药物处方确定的。我们使用考克斯回归，以评估出生CS和ADHD的总研究人群之间的关联，调整围产期和社会人口因素，然后分层考克斯回归分析母亲识别号码，以评估兄弟姐妹之间的关联。在队列中，与无辅助VD相比，选择性CS与ADHD之间关联的风险比（HR）为1.15 [95%置信区间（CI）：1.11 - 1.20]，分层分析中为1.05（95% CI：0.93 - 1.18）。在队列中，紧急CS与ADHD之间的关联的HR为1.16（95%CI：1.12 - 1.20），在分层分析中为1.13（95%CI：1.01 - 1.26）。然而，在兄弟姐妹中，这种联系只存在于紧急CS中。如果这是CS的因果效应，则预期两种类型的CS的相关性将持续存在，表明观察到的相关性是由于混杂因素。
Background: It has been suggested that birth by caesarean section (CS) may affect psychological development through changes in microbiota or stress response. We assessed the impact of mode of delivery, specifically CS, on the development of attention-deficit/hyperactivity disorder (ADHD), using a large, population-based cohort.Methods: The study cohort consisted of all singleton live births in Sweden from 1990 to 2008 using data from Swedish national registers. Mode of delivery included: unassisted vaginal delivery(VD), assisted VD, elective CS or emergency CS. ADHD was determined using International Classification of Diseases version 10 (F90 or F98.8), or prescription for ADHD medication. We used Cox regression to assess the association between birth by CS and ADHD in the total study population, adjusting for perinatal and sociodemographic factors, then stratified Cox regression analysis on maternal identification number to assess the association among siblings.Results: Our cohort consisted of 1 722 548 children, and among these 47 778 cases of ADHD. The hazard ratio (HR) of the association between elective CS, compared with unassisted VD, and ADHD was 1.15 [95% confidence interval (CI): 1.11-1.20] in the cohort, and 1.05 (95% CI: 0.93-1.18) in the stratified analysis. The HR of the association between emergency CS and ADHD was 1.16 (95% CI: 1.12-1.20])in the cohort and 1.13 (95% CI: 1.01-1.26) in the stratified analysis.Conclusion: Birth by CS is associated with a small increased risk of ADHD. However among siblings the association only remained for emergency CS. If this were a causal effect by CS, the association would be expected to persist for both types of CS, suggesting the observed association is due to confounding.