摘要
目的评估母亲孕前超重、肥胖与子代发生注意缺陷多动障碍(ADHD)的关系。方法检索中国知网数据库、万方数据库、中国生物医学文献数据库、PubMed、Embase、Cochrane数据库;检索时间为建库至2020年2月11日;母亲孕前BMI、儿童ADHD和队列研究的主题词和自由词构建检索式。由2人分别按照初筛和全文筛选标准独立筛选文献和提取数据,纳入母亲孕前超重/肥胖子代发生ADHD的队列研究根据孕前BMI判断消瘦、正常、超重和肥胖,采用父母和教师ADHD评估量表评估ADHD,ADHD分为注意缺陷、多动冲动和混合型;采集不同队列研究的暴露因素。队列研究采用NOS量表评价偏倚风险。采用Stata15.0软件进行数据分析。结果 13篇队列研究文献进入本文Meta分析,包括16个队列,12篇为前瞻性队列研究,队列总人数801 834(511~649 043,中位3 803)例。Meta分析结果显示:(1)母亲孕前消瘦不增加子代ADHD发生风险[OR=1.05(95%CI:0.97~1.13),I2=0];母亲孕期超重、肥胖增加子代ADHD发生风险[OR=1.21(95%CI:1.16~1.27),I2=18.3%;OR=1.35(95%CI:1.19~1.55),I2=84.0%]。(2)临床异质性分析:①以队列地区行亚组分析,欧洲队列母亲孕前超重、肥胖OR(95%CI)分别为1.22(1.19~1.26)、1.45(1.31~1.61),北美队列母亲孕前超重、肥胖OR(95%CI)分别为1.14(0.85~1.52)、1.94(1.05~3.58);②以子代年龄(学龄前期、学龄期和未提供随访年龄)行亚组分析,母亲肥胖与学龄前期子代ADHD发生风险不相关;③以子代ADHD分型行亚组分析,母亲孕前超重、肥胖增加混合型ADHD发生风险,OR(95%CI)分别为1.22(1.19~1.25)、1.41(1.22~1.63),母亲孕前超重增加注意缺陷型ADHD发生风险,OR(95%CI)为1.40(1.06~1.87)。分别采用Begg秩相关法、Egger直线回归法,未发现明显发表偏倚。结论孕前消瘦不会显著增加后代ADHD风险,孕前超重与肥胖可增加后代ADHD风险。
Objective To evaluate the relationship between maternal pre⁃pregnancy overweight/obese status and offspring attention deficit hyperactivity disorder(ADHD).Methods The Chinese and English databases,including CNKI,Wanfang Data,Sinomed,PubMed,Embase,and Cochrane library,were searched for cohort studies on the association between maternal overweight/obese status before pregnancy and offspring ADHD from the time of establishment to 11th February,2020.The retrieving methods combined Mesh subject terms and free terms related to maternal pre⁃pregnancy BMI,offspring ADHD and cohort.Two researchers did the primary and full⁃text selection and extracted data individually.Pre⁃pregnancy BMI was the only indicator for the classification of being underweight,normal,overweight and obese.ADHD evaluation scale was filled by teachers or parents,and inattention,hyperactivity/impulsivity or combined type of ADHD were counted.Exposure factors of different cohorts were extracted.Newcastle⁃Ottawa scale(NOS)was used for quality assessment.Data analysis was performed by Stata 15.0.Results A total of 13 studies were included in this study with 16 cohorts and 12 of them were prospective cohort studies.A total of 801,834(511⁃649,043,median 3,803)subjects were recruited.The results of the meta⁃analysis showed that both of being maternal overweight(OR=1.21,95%CI:1.16⁃1.27,I2=18.3%)and obese(OR=1.35,95%CI:1.19⁃1.55,I2=84.0%)were significantly associated with offspring ADHD,while being maternal underweight was not significantly associated with ADHD(OR=1.05,95%CI:0.97⁃1.13,I2=0%).Heterogeneity analysis results showed that:a.Regional subgroup analysis revealed the results of being pre⁃pregnancy overweight and obese in European and North America cohort was OR=1.22(95%CI,1.19⁃1.26),OR=1.45(95%CI,1.31⁃1.61)and OR=1.14(95%CI,0.85⁃1.52),OR=1.94(95%CI,1.05⁃3.58),respectively.b.Subgroup analysis based on offspring age(preschool,school age and not given)indicated pre⁃pregnancy obesity was not related to increased risk of pre
作者
王冉
石奇琪
贾兵
WANG Ran;SHI Qiqi;JIA Bing(Children's Hospital of Fudan University Department of Neonatology,Shanghai 201102,China;Children's Hospital of Fudan University Department of Cardiothoracic Surgery,Shanghai 201102,China)
出处
《中国循证儿科杂志》
CSCD
北大核心
2020年第5期344-350,共7页
Chinese Journal of Evidence Based Pediatrics
