孕婦在懷孕前肥胖有糖尿病 與孩子的自閉症有關


  【24drs.com】根據線上發表於1月29日小兒科期刊的生育世代研究,孕婦在懷孕前肥胖且有糖尿病,與合併智力障礙(intellectual disabilities,IDs)之泛自閉症障礙(autism spectrum disorder,ASD)風險增加有關。研究結果認為,有IDs之ASD的病因可能和沒有IDs之ASD的病因截然不同。
  
  馬里蘭州巴爾的摩約翰霍普金斯彭博公衛學院人口家庭暨生殖健康系Mengying Li等人寫道,越來越多證據認為,ASD可能與孕婦肥胖及糖尿病相關的免疫與代謝異常有關。對於發育中的胎兒腦部,同時發生肥胖和糖尿病可能是多重打擊,讓胎兒的ASD風險比只有單一種狀況者更高。需要更大型的後續研究,以正式檢視母體肥胖和糖尿病之間的潛在相互作用。
  
  以前的研究顯示,孕婦糖尿病會增加孩子的ASD風險,但是,有關孕婦肥胖的研究結果並不一致,作者們寫道,沒有研究探討同時有這兩種狀況時的影響。
  
  因此,研究者在1998-2014年間、分析了納入波士頓生育世代和在波士頓醫學中心就診一次以上出生後檢查的2,734名孩童(包括102名ASD孩童)的資料,採用電子病歷中的醫師診斷確認ASD和其他發育障礙(DDs)。
  
  單一變項分析中,孕婦在懷孕前肥胖、妊娠前糖尿病(pregestational diabetes,PGDM)、極低出生體重、抽菸都與ASD顯著相關。
  
  當研究者校正了潛在的干擾因素之後,母體肥胖,不論有無PGDM,子代的ASD風險幾近2倍(風險比[HR]為1.92;95%信賴區間[CI]為1.20 - 3.07),同樣地,PGDM、不論有無肥胖,和風險大於2倍有關(HR, 2.25;95% CI, 1.14 - 4.42),不過,妊娠糖尿病和ASD風險不再顯著相關。
  
  當研究者根據肥胖和糖尿病狀態將孕婦分成6組時,他們發現,ASD風險集中於那些肥胖且有糖尿病的婦女。具體而言,肥胖且PGDM的媽媽中,ASD風險幾近4倍(HR, 3.91;95% CI, 1.76 - 8.68),肥胖且有妊娠糖尿病者中,風險增加3倍(HR, 3.04;95% CI, 1.21 - 7.63),其他組別的風險並無顯著增加。
  
  IDs的風險增加情況有類似模式,其他的DDs則無。
  
  研究作者寫道,孕婦同時有肥胖和糖尿病時,ASD風險比單獨有肥胖或糖尿病更高,特別是ASD同時有[ID]時,ASD同時有或沒有[ID]的病理機轉截然不同。
  
  研究限制包括,ASD和DD的分類可能錯誤、可能有取樣偏差、無法掌握2003年前的產後檢查、潛在的干擾因素,可能無法一般化到其他族群。
  
  資料來源:http://www.24drs.com/
  
  Native link:Maternal Prepregnancy Obesity, Diabetes Linked to Autism

Maternal Prepregnancy Obesity, Diabetes Linked to Autism

By Laurie Barclay, MD
Medscape Medical News

Maternal prepregnancy obesity combined with diabetes was associated with increased risk for autism spectrum disorder (ASD) and intellectual disabilities (IDs), according to a birth cohort study published online January 29 in Pediatrics. The findings suggest that ASD with IDs may be etiologically distinct from ASD without IDs.

"Growing evidence suggests that ASD may be related to immunologic and metabolic disturbances associated with maternal obesity and diabetes," write Mengying Li, MSPH, from the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and colleagues. "Cooccurring obesity and diabetes may be 'multiple hits' to the developing fetal brain, conferring an even higher risk of ASD in the offspring than a single condition. Future studies of a larger size are needed to formally test potential interactions between maternal obesity and diabetes."

Previous studies have shown that maternal diabetes increases the risk of ASD in offspring, but the data have been inconsistent for maternal obesity. "No study has examined the combined effects of the 2 conditions," the authors write.

Therefore, they analyzed data from 2734 children (including 102 with ASD) who were enrolled in the Boston Birth Cohort and who completed one or more postnatal study visits at Boston Medical Center between 1998 and 2014. Physician diagnoses in electronic medical records allowed determination of ASD and other developmental disabilities (DDs).

In univariate analyses, maternal prepregnancy obesity, pregestational diabetes (PGDM), very low birth weight, and smoking were significantly associated with ASD.

When the researchers adjusted for potential confounders, maternal obesity, irrespective of PGDM, was tied to a nearly twofold risk for ASD in offspring (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.20 - 3.07). Similarly, PGDM, irrespective of obesity, was associated with a greater than twofold risk (HR, 2.25; 95% CI, 1.14 - 4.42). However, gestational diabetes was no longer significantly associated with ASD risk.

When the researchers grouped the mothers into six groups according to obesity and diabetes status, they found that the risk for ASD concentrated among those women who were obese and had diabetes. Specifically, among mothers with obesity and PGDM, the risk for ASD was nearly fourfold (HR, 3.91; 95% CI, 1.76 - 8.68), and among those with obesity and gestational diabetes, the risk was increased threefold (HR, 3.04; 95% CI, 1.21 - 7.63). The other groups showed no significantly increased risk.

There was a similar pattern of increased risk for IDs, but not other DDs.

"The combination of maternal obesity and diabetes was associated with greater risk of ASD than either obesity or diabetes alone, in particular when ASD co-occurred with [ID]," the study authors write. "ASD with and without [ID] may be etiologically distinct."

Limitations of this study include possible misclassification of ASD and DD, possible selection bias, failure to capture postnatal visits before 2003, potential residual confounding, and possible lack of generalizability to other populations.

The parent study was supported in part by the March of Dimes, National Institute of Environmental Health Sciences, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The follow-up study is supported in part by the Ludwig Family Foundation, the National Institute of Allergy and Infectious Diseases, and the Maternal and Child Health Bureau (R40MC27443). Li is supported by the Josephine Kohn and Family Fund and the Bernard and Jane Guyer Scholarship. Funded by the National Institutes of Health. The remaining authors have disclosed no relevant financial relationships.

Pediatrics. Published online January 29, 2016.

    
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