孕妇在怀孕前肥胖有糖尿病 与孩子的自闭症有关


  【24drs.com】根据在线发表于1月29日小儿科期刊的生育世代研究,孕妇在怀孕前肥胖且有糖尿病,与合并智力障碍(intellectual disabilities,IDs)之泛自闭症障碍(autism spectrum disorder,ASD)风险增加有关。研究结果认为,有IDs之ASD的病因可能和没有IDs之ASD的病因截然不同。
  
  马里兰州巴尔的摩约翰霍普金斯彭博公卫学院人口家庭暨生殖健康系Mengying Li等人写道,越来越多证据认为,ASD可能与孕妇肥胖及糖尿病相关的免疫与代谢异常有关。对于发育中的胎儿脑部,同时发生肥胖和糖尿病可能是多重打击,让胎儿的ASD风险比只有单一种状况者更高。需要更大型的后续研究,以正式检视母体肥胖和糖尿病之间的潜在相互作用。
  
  以前的研究显示,孕妇糖尿病会增加孩子的ASD风险,但是,有关孕妇肥胖的研究结果并不一致,作者们写道,没有研究探讨同时有这两种状况时的影响。
  
  因此,研究者在1998-2014年间、分析了纳入波士顿生育世代和在波士顿医学中心就诊一次以上出生后检查的2,734名孩童(包括102名ASD孩童)的资料,采用电子病历中的医师诊断确认ASD和其它发育障碍(DDs)。
  
  单一变项分析中,孕妇在怀孕前肥胖、妊娠前糖尿病(pregestational diabetes,PGDM)、极低出生体重、抽菸都与ASD显著相关。
  
  当研究者校正了潜在的干扰因素之后,母体肥胖,不论有无PGDM,子代的ASD风险几近2倍(风险比[HR]为1.92;95%信赖区间[CI]为1.20 - 3.07),同样地,PGDM、不论有无肥胖,和风险大于2倍有关(HR, 2.25;95% CI, 1.14 - 4.42),不过,妊娠糖尿病和ASD风险不再显著相关。
  
  当研究者根据肥胖和糖尿病状态将孕妇分成6组时,他们发现,ASD风险集中于那些肥胖且有糖尿病的妇女。具体而言,肥胖且PGDM的妈妈中,ASD风险几近4倍(HR, 3.91;95% CI, 1.76 - 8.68),肥胖且有妊娠糖尿病者中,风险增加3倍(HR, 3.04;95% CI, 1.21 - 7.63),其它组别的风险并无显著增加。
  
  IDs的风险增加情况有类似模式,其它的DDs则无。
  
  研究作者写道,孕妇同时有肥胖和糖尿病时,ASD风险比单独有肥胖或糖尿病更高,特别是ASD同时有[ID]时,ASD同时有或没有[ID]的病理机转截然不同。
  
  研究限制包括,ASD和DD的分类可能错误、可能有取样偏差、无法掌握2003年前的产后检查、潜在的干扰因素,可能无法一般化到其它族群。
  
  资料来源: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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