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Duko B, Gebremedhin AT, Tessema GA, Dunne J, Alati R, Pereira G. The effects of pre-eclampsia on social and emotional developmental vulnerability in children at age five in Western Australia: A population data linkage study. J Affect Disord 2024; 352:349-356. [PMID: 38360367 DOI: 10.1016/j.jad.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND It is important to explore factors that may hinder early childhood development in AEDC Emotional Maturity and Social Competence domains as these underpin the foundation for health, well-being, and productivity over the life course. No previous study has examined whether, or to what extent, preeclampsia increases the risk of developmental vulnerability in social and emotional domains in early childhood. METHODS We conducted a retrospective population-based cohort study on the association between preeclampsia and childhood developmental vulnerability in emotional maturity and social competence domains in children born in Western Australia in 2009, 2012 and 2015. We obtained records of births, developmental anomalies, midwives notifications and hospitalisations. These data were linked to the Australian Early Development Census (AEDC), from which developmental vulnerability in emotional maturity and social competence domains at a median age of 5 years was ascertained. Causal relative risks (RR) were estimated with doubly robust estimation. RESULTS A total of 64,391 mother-offspring pairs were included in the final analysis. For the whole cohort, approximately 25 % and 23 % of children were classified as developmentally vulnerable or at-risk on AEDC emotional maturity and social competence domains, respectively. Approximately 2.8 % of children were exposed in utero to preeclampsia. Children exposed to preeclampsia were more likely to be classified as developmentally vulnerable or at-risk on the emotional maturity (RR = 1.19, 95%CI:1.11-1.28) and social competence domains (RR = 1.22, 95 % CI:1.13-1.31). CONCLUSION Children exposed to pre-eclampsia in utero were more likely to be developmentally vulnerable in emotional maturity and social competence domains in this cohort. Our findings provide new insights into the harmful effect of preeclampsia on childhood developmental vulnerability.
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Affiliation(s)
- Bereket Duko
- Australian Centre for Precision Health, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; Curtin School of Population Health, Curtin University, Kent St, Bentley, WA 6102, Australia; South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia.
| | | | - Gizachew Assefa Tessema
- Curtin School of Population Health, Curtin University, Kent St, Bentley, WA 6102, Australia; enAble Institute, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
| | - Jennifer Dunne
- Curtin School of Population Health, Curtin University, Kent St, Bentley, WA 6102, Australia
| | - Rosa Alati
- Curtin School of Population Health, Curtin University, Kent St, Bentley, WA 6102, Australia; enAble Institute, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia; Institute for Social Sciences Research, The University of Queensland, 80 Meier's Rd, Indooroopilly, Queensland 4068, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Kent St, Bentley, WA 6102, Australia; enAble Institute, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
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2
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Keenan M, Khashan AS, O'Byrne LJ, O'Keeffe GW, Al Khalaf S, Maher GM. Maternal hypertensive disorders of pregnancy and depression or anxiety in adolescence: Findings from the Millennium Cohort Study. J Affect Disord 2024; 347:23-28. [PMID: 37981036 DOI: 10.1016/j.jad.2023.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/24/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The short-term effects of hypertensive disorders of pregnancy (HDP) on the health of the fetus are well known; however, their impacts on the risk of mental health in the exposed offspring are not fully understood. Our aim was to examine the association between HDP and depression/anxiety at age 17 years. METHODS We used data from The Millennium Cohort Study, a nationally representative longitudinal study of children born in the United Kingdom. Data on HDP and potential confounders were collected when children were 9-months. Data on depression and anxiety were collected as one variable when children were aged 17 years using self-reported doctor diagnosis, and reclassified as depression/anxiety (overall), depression/anxiety with treatment, and depression/anxiety without treatment. Crude and adjusted logistic regression models were performed to examine the association between HDP and depression/anxiety, adjusting for several maternal and socio-economic factors. RESULTS There were 9517 singleton mother-child pairs included in the analyses. Adjusted logistic regression suggested an association between HDP and depression/anxiety (adjusted odds ratio, (aOR):1.30 [95 % CI, 1.02-1.66]) at age 17 years. A similar association was observed for HDP and depression/anxiety with treatment (aOR:1.33 [95 % CI, 1.01-1.73]) and HDP and depression/anxiety without treatment (aOR: 1.30 [95 % CI, 0.80-2.12]), although the latter did not reach statistical significance. LIMITATIONS Data on severity and classifications of HDP were not available. CONCLUSION Exposure to HDP may be associated with an increased likelihood of depression or anxiety at age 17 years. Future research should consider severity and different classifications of HDP.
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Affiliation(s)
- Martin Keenan
- School of Public Health, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland
| | - Laura J O'Byrne
- School of Public Health, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Gerard W O'Keeffe
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Sukainah Al Khalaf
- School of Public Health, University College Cork, Cork, Ireland; Mohammed Al-Mana College for Medical Sciences, Saudi Arabia
| | - Gillian M Maher
- School of Public Health, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland.
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3
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Wilson EN, Mabry S, Bradshaw JL, Gardner JJ, Rybalchenko N, Engelland R, Fadeyibi O, Osikoya O, Cushen SC, Goulopoulou S, Cunningham RL. Gestational hypoxia in late pregnancy differentially programs subcortical brain maturation in male and female rat offspring. Biol Sex Differ 2022; 13:54. [PMID: 36175941 PMCID: PMC9524087 DOI: 10.1186/s13293-022-00463-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hypoxia is associated with pregnancy complications, such as preeclampsia, placental abruption, and gestational sleep apnea. Hypoxic insults during gestation can impact the brain maturation of cortical and subcortical pathways, such as the nigrostriatal pathway. However, the long-term effects of in utero hypoxic stress exposure on brain maturation in offspring are unclear, especially exposure during late gestation. The purpose of this study was to determine the impact of gestational hypoxia in late pregnancy on developmental programming of subcortical brain maturation by focusing on the nigrostriatal pathway. Methods Timed pregnant Long–Evans rats were exposed to chronic intermittent hypoxia or room air normoxia from gestational day (GD) 15–19 (term 22–23 days). Male and female offspring were assessed during two critical periods: puberty from postnatal day (PND) 40–45 or young adulthood (PND 60–65). Brain maturation was quantified by examining (1) the structural development of the nigrostriatal pathway via analysis of locomotor behaviors and the substantia nigra dopaminergic neuronal cell bodies and (2) the refinement of the nigrostriatal pathway by quantifying ultrasonic vocalizations (USVs). Results The major findings of this study are gestational hypoxia has age- and sex-dependent effects on subcortical brain maturation in offspring by adversely impacting the refinement of the nigrostriatal pathway in the absence of any effects on the structural development of the pathway. During puberty, female offspring were impacted more than male offspring, as evidenced by decreased USV call frequency, chirp USV call duration, and simple call frequency. In contrast, male offspring were impacted more than female offspring during young adulthood, as evidenced by increased latency to first USV, decreased simple USV call intensity, and increased harmonic USV call bandwidth. No effects of gestational hypoxia on the structural development of the nigrostriatal pathway were observed. Conclusions These novel findings demonstrate hypoxic insults during pregnancy mediate developmental programming of the cortical and subcortical pathways, in which male offspring exhibit long-term adverse effects compared to female offspring. Impairment of cortical and subcortical pathways maturation, such as the nigrostriatal pathway, may increase risk for neuropsychiatric disorders (e.g., mood disorders, cognitive dysfunction, brain connectivity dysfunction). Supplementary Information The online version contains supplementary material available at 10.1186/s13293-022-00463-x. Brain maturation of the nigrostriatal pathway is sex- and age- dependent. Exposure to hypoxia in late pregnancy impacts brain maturation of the nigrostriatal pathway that can be observed during puberty and young adulthood. Gestational hypoxia impacted female offspring during puberty more than males, whereas it impacted male offspring during young adulthood more than females. These novel findings demonstrate that hypoxic insults during pregnancy mediate developmental programming of the cortical and subcortical pathways, in which male offspring exhibit long-term adverse effects compared to female offspring. Long-term adverse effects of gestational hypoxia in offspring can occur in the absence of pregnancy complications, especially if they occur within critical embryological developmental periods.
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Affiliation(s)
- E Nicole Wilson
- Department of Pharmaceutical Sciences, UNT System College of Pharmacy, School of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
| | - Steve Mabry
- Department of Pharmaceutical Sciences, UNT System College of Pharmacy, School of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
| | - Jessica L Bradshaw
- Department of Pharmaceutical Sciences, UNT System College of Pharmacy, School of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
| | - Jennifer J Gardner
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA.,Department of Pharmaceutical Sciences, UNT System College of Pharmacy, School of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
| | - Nataliya Rybalchenko
- Department of Pharmaceutical Sciences, UNT System College of Pharmacy, School of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
| | - Rachel Engelland
- Department of Pharmaceutical Sciences, UNT System College of Pharmacy, School of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
| | - Oluwadarasimi Fadeyibi
- Department of Pharmaceutical Sciences, UNT System College of Pharmacy, School of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
| | - Oluwatobiloba Osikoya
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | - Spencer C Cushen
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA.,Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | - Styliani Goulopoulou
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA.,Department of Basic Sciences, Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, UNT System College of Pharmacy, School of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA.
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Ståhlberg T, Upadhyaya S, Polo-Kantola P, Khanal P, Luntamo T, Hinkka-Yli-Salomäki S, Sourander A. Associations Between Delivery Modes, Birth Outcomes and Offspring Anxiety Disorders in a Population-Based Birth Cohort of Children and Adolescents. Front Psychiatry 2022; 13:917299. [PMID: 35911234 PMCID: PMC9326080 DOI: 10.3389/fpsyt.2022.917299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Mode of delivery and well-being markers for newborn infants have been associated with later psychiatric problems in children and adolescents. However, only few studies have examined the association between birth outcomes and anxiety disorders and the results have been contradictory. METHODS This study was a Finnish population-based register study, which comprised 22,181 children and adolescents with anxiety disorders and 74,726 controls. Three national registers were used to collect the data on exposures, confounders and outcomes. Mode of delivery, the 1-min Apgar score, umbilical artery pH and neonatal monitoring were studied as exposure variables for anxiety disorders and for specific anxiety disorders. Conditional logistic regression was used to examine these associations. RESULTS Unplanned and planned cesarean sections increased the odds for anxiety disorders in children and adolescents (adjusted OR 1.08, 95% CI 1.02-1.15 and aOR 1.12, 95% CI 1.05-1.19, respectively). After an additional adjustment for maternal diagnoses, unplanned cesarean sections remained statistically significant (aOR 1.11, 95% CI 1.04-1.18). For specific anxiety disorders, planned cesarean sections and the need for neonatal monitoring increased the odds for specific phobia (aOR 1.21, 95% CI 1.01-1.44 and aOR 1.28, 95% CI 1.07-1.52, respectively). CONCLUSIONS Birth by cesarean section increased the odds for later anxiety disorders in children and adolescents and unplanned cesarean sections showed an independent association. Further studies are needed to examine the mechanisms behind these associations.
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Affiliation(s)
- Tiia Ståhlberg
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland
| | - Subina Upadhyaya
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Prakash Khanal
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland
| | - Terhi Luntamo
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | | | - Andre Sourander
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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Faltyn M, Savoy C, Krzeczkowski JE, Ferro MA, Colman I, Van Lieshout RJ. Exploring Links Between Prenatal Adversity and Adolescent Psychiatric Risk in a Canadian Population-Based Sample. J Dev Behav Pediatr 2021; 42:457-462. [PMID: 33538536 DOI: 10.1097/dbp.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Adverse prenatal and postnatal exposures may have long-lasting effects on health and development. However, it remains unclear whether being exposed to a greater number of prenatal adversities affects mental health risk. The current study examined whether exposure to maternal health problems prenatally is associated with an increasing risk of psychiatric morbidity in adolescents. METHODS Using data from the 2014 Ontario Child Health Study (OCHS), we examined associations between a count of 7 prenatal risk factors (maternal hypertension, diabetes mellitus, bleeding during pregnancy, influenza, urinary tract infection, thyroid disease, and depression/anxiety) and adolescent psychiatric morbidity. Adolescents (N = 2219) aged 12 to 17 years were assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents. RESULTS Exposure to each additional prenatal adversity was correlated with increased odds of attention-deficit/hyperactivity disorder (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.03-1.60), generalized anxiety disorder (OR = 1.27, 95% CI = 1.05-1.55), and social anxiety disorder (OR = 1.35, 95% CI = 1.01-1.80) after adjustment for confounding variables. CONCLUSION Exposure to prenatal adversity in the form of maternal health problems was correlated with an increased risk of attention deficit hyperactivity disorder and anxiety disorders in adolescence. Future studies should further investigate the effects of antenatal environmental exposures on these associations to determine the potential value of close monitoring of those exposed to prenatal risks.
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Affiliation(s)
- Mateusz Faltyn
- Arts and Science Undergraduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Calan Savoy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - John E Krzeczkowski
- Neuroscience Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Abstract
While donor-conceived children have similar mental health outcomes compared to spontaneously conceived children, there is an inconsistency between studies investigating mental health outcomes of donor-conceived people in adulthood. This study is an online health survey that was completed by 272 donor sperm-conceived adults and 877 spontaneously conceived adults from around the world. Donor sperm-conceived adults had increased diagnoses of attention deficit disorder (P = 0.004), and autism (P = 0.044) in comparison to those conceived spontaneously. Donor sperm-conceived adults self-reported increased incidences of seeing a mental health professional (P < 0.001), identity formation problems (P < 0.001), learning difficulties (P < 0.001), panic attacks (P = 0.038), recurrent nightmares (sperm P = 0.038), and alcohol/drug dependency (P = 0.037). DASS-21 analysis revealed that donor sperm-conceived adults were also more stressed than those conceived spontaneously (P = 0.013). Both donor sperm and spontaneously conceived cohorts were matched for sex, age, height, alcohol consumption, smoking, exercise, own fertility, and maternal smoking. The increase in adverse mental health outcomes is consistent with some studies of donor-conceived adult mental health outcomes. These results are also consistent with the Developmental Origins of Health and Disease (DOHaD) phenomenon that has linked adverse perinatal outcomes, which have been observed in donor-conceived neonates, to increased risk of chronic disease, including mental health. Further work is required to reconcile our observations in adults to contrary observations reported in donor-conceived children.
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7
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Robinson R, Lähdepuro A, Tuovinen S, Girchenko P, Rantalainen V, Heinonen K, Lahti J, Räikkönen K, Lahti-Pulkkinen M. Maternal Hypertensive Pregnancy Disorders and Mental and Behavioral Disorders in the Offspring: a Review. Curr Hypertens Rep 2021; 23:30. [PMID: 33982182 PMCID: PMC8116290 DOI: 10.1007/s11906-021-01141-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 12/19/2022]
Abstract
Purpose of Review We review here recent original research and meta-analytic evidence on the associations of maternal hypertensive pregnancy disorders and mental and behavioral disorders in the offspring. Recent Findings Seven meta-analyses and 11 of 16 original research studies published since 2015 showed significant associations between maternal hypertensive pregnancy disorders and offspring mental and behavioral disorders. Evidence was most consistent in meta-analyses and high-quality cohort studies. The associations, independent of familial confounding, were observed on different mental and behavioral disorders in childhood and schizophrenia in adulthood. Preterm birth and small-for-gestational age birth emerged as possible moderators and mediators of the associations. Cross-sectional and case-control studies yielded inconsistent findings, but had lower methodological quality. Summary Accumulating evidence from methodologically sound studies shows that maternal hypertensive pregnancy disorders are associated with an increased risk of mental and behavioral disorders in the offspring in childhood. More studies on adult mental disorders are needed. Supplementary Information The online version contains supplementary material available at 10.1007/s11906-021-01141-w.
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Affiliation(s)
- Rachel Robinson
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 9, FI-00014 University of Helsinki, Helsinki, Finland
| | - Anna Lähdepuro
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 9, FI-00014 University of Helsinki, Helsinki, Finland
| | - Soile Tuovinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 9, FI-00014 University of Helsinki, Helsinki, Finland
| | - Polina Girchenko
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 9, FI-00014 University of Helsinki, Helsinki, Finland
| | - Ville Rantalainen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 9, FI-00014 University of Helsinki, Helsinki, Finland
| | - Kati Heinonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 9, FI-00014 University of Helsinki, Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 9, FI-00014 University of Helsinki, Helsinki, Finland
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 9, FI-00014 University of Helsinki, Helsinki, Finland
| | - Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 9, FI-00014 University of Helsinki, Helsinki, Finland. .,National Institute for Health and Welfare, Helsinki, Finland. .,Queens Medical Research Unit, University of Edinburgh, Edinburgh, UK.
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Ding X, Wang J, Li N, Su W, Wang H, Song Q, Guo X, Liang M, Qin Q, Sun L, Chen M, Sun Y. Individual, Prenatal, Perinatal, and Family Factors for Anxiety Symptoms Among Preschool Children. Front Psychiatry 2021; 12:778291. [PMID: 34987428 PMCID: PMC8721098 DOI: 10.3389/fpsyt.2021.778291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/19/2021] [Indexed: 01/21/2023] Open
Abstract
Anxiety is one of the most common psychological disorders among children. Few studies have investigated the prevalence and comprehensive factors for anxiety among preschool children in China. This study aimed to assess the prevalence of anxiety and explore influential factors at multiple levels including individual, prenatal and perinatal, and family factors, associated with anxiety symptoms among preschool children. The multisite cross-sectional study was conducted in Anhui Province and included 3,636 preschool children aged 3-6 years. Anxiety symptoms of children were assessed using the Chinese version of the Spence Preschool Anxiety Scale. Logistic regression analyses were performed to explore associations between factors at multiple levels and significant anxiety symptoms, and the model was validated internally using 10-fold cross-validation. Among the participants, 9.1% of children had significant anxiety symptoms. Girls reported more significant anxiety symptoms. Children's poor dietary habits, sleep disturbances, autistic tendencies, and left-behind experience; maternal poor prenatal emotional symptoms; and more caregivers' anxiety symptoms were significantly associated with anxiety symptoms among children. The result of 10-fold cross-validation indicated that the mean area under the curve, sensitivity, specificity, and accuracy were 0.78, 70.45%, 78.18%, and 71.15%, respectively. These factors were slightly different among different subtypes of anxiety symptoms. The results of this study suggested that anxiety symptoms in preschool children were prevalent, particularly in girls. Understanding early-life risk factors for anxiety is crucial, and efficient prevention and intervention strategies should be implemented in early childhood even pregnancy.
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Affiliation(s)
- Xiuxiu Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Jun Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China.,Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Ning Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Wanying Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Qiuxia Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Qirong Qin
- Ma'anshan Center for Disease Control and Prevention, Ma'anshan, China
| | - Liang Sun
- Fuyang Center for Disease Control and Prevention, Fuyang, China
| | - Mingchun Chen
- Changfeng Center for Disease Control and Prevention, Changfeng, China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
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9
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Ståhlberg T, Khanal P, Chudal R, Luntamo T, Kronström K, Sourander A. Prenatal and perinatal risk factors for anxiety disorders among children and adolescents: A systematic review. J Affect Disord 2020; 277:85-93. [PMID: 32799108 DOI: 10.1016/j.jad.2020.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Prenatal and perinatal risk factors for anxiety disorders have rarely been studied, even though they are highly prevalent in children and adolescents. It is important to identify the common risk factors, so that targeted preventive care and early interventions can be provided. METHODS A systematic review of the PubMed and PsycInfo databases was conducted to 25 October 2019, according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses guidelines. The protocol was registered on the Prospective Register of Systematic Reviews and the quality assessment was carried out using the Joanna Briggs tools. RESULTS The review identified 31 studies from eight countries, including three register studies. Cohort sizes ranged from 69 to 89,404 and diagnoses cases ranged from 4 to 7867. Although various risk factors had been researched, only few of them had been repeatedly studied and the findings were highly inconsistent. The associations between the different risk factors and anxiety disorders seemed weak compared to many other psychiatric disorders, but preterm birth and maternal somatic illnesses may increase the risk for anxiety disorders in offspring. LIMITATIONS The studies varied considerably by study design, risk factors and anxiety disorders studied, sample sizes and follow up periods. CONCLUSIONS Prenatal and perinatal risk factors for anxiety disorders have been under-researched, compared to other psychiatric disorders. Our systematic review found weak links to prenatal events, but flagged up preterm birth and maternal somatic illnesses as possible avenues for future research.
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Affiliation(s)
- Tiia Ståhlberg
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland.
| | - Prakash Khanal
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland
| | - Roshan Chudal
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland
| | - Terhi Luntamo
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland
| | - Kim Kronström
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland; Department of Adolescent Psychiatry, Turku University Hospital, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland; Turku University Hospital, Turku, Finland; INVEST Research Flagship, University of Turku, (Principal Investigator), Turku, Finland
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10
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Dachew BA, Scott JG, Mamun A, Alati R. Hypertensive disorders of pregnancy and emotional and behavioural problems in children: a longitudinal population-based study. Eur Child Adolesc Psychiatry 2020; 29:1339-1348. [PMID: 31758357 DOI: 10.1007/s00787-019-01443-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/12/2019] [Indexed: 12/31/2022]
Abstract
There is evidence that offspring of mothers who have hypertensive disorders of pregnancy (HDP) are at increased risk of adverse health outcomes. This study aims to examine the association between maternal HDP and emotional- and behavioural problems in offspring at age 11 years as reported by teachers and parents. The current study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, population-based study that has followed a cohort of offspring since their mothers were pregnant. Childhood emotional- and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ), completed by parents (n = 7196) and the child's teacher (n = 7411). Maternal preeclampsia, but not gestational hypertension, was associated with teacher-reported total behavioural difficulties (RR = 1.62; 95% CI 1.03-2.52) and internalising problems in children [peer problems (RR = 1.48; 95% CI 1.06-2.08) and emotional problems (RR = 1.68; 95% CI 1.13-2.51)]. No associations between preeclampsia and/or gestational hypertension and parent-reported emotional- and behaviour problems were observed. Our study showed that children exposed to preeclampsia had higher risk of teacher-reported total behavioural difficulties and internalising problems compared with unexposed children. The findings suggest emotional- and behavioural difficulties may not be evident in all settings, hence the importance of collecting evidence from multiple informants.
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Affiliation(s)
- Berihun Assefa Dachew
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia. .,Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - James G Scott
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia.,Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia
| | - Rosa Alati
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
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Lahti-Pulkkinen M, Girchenko P, Tuovinen S, Sammallahti S, Reynolds RM, Lahti J, Heinonen K, Lipsanen J, Hämäläinen E, Villa PM, Kajantie E, Laivuori H, Räikkönen K. Maternal Hypertensive Pregnancy Disorders and Mental Disorders in Children. Hypertension 2020; 75:1429-1438. [DOI: 10.1161/hypertensionaha.119.14140] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The associations of maternal hypertensive pregnancy disorders with offspring mental disorders remain unclear. We examined whether maternal hypertensive disorders and maximum blood pressure during pregnancy predict offspring childhood mental disorders, whether the associations are independent of maternal and paternal mental disorders and paternal hypertensive disorders, independent of or additive with maternal early pregnancy overweight/obesity and diabetes mellitus disorders, and mediated or moderated by preterm birth, small-for-gestational-age birth and neonatal intensive care unit admission. Our prospective study comprised 4743 mother-child dyads of Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction study. Women were recruited to the study in early pregnancy at Finnish maternity hospitals. Children were born 2006 to 2010 and followed-up until December 31, 2016, to ages 6.4 to 10.8 years. Hypertensive pregnancy disorders were identified from medical records, Medical Birth Register, and Care Register for Health Care. Systolic and diastolic blood pressure were measured at antenatal clinics and hospital visits. Mental disorder diagnoses were identified from Care Register for Health Care. Maternal gestational and chronic hypertension, preeclampsia and its severity increased offspring hazard of any childhood mental disorder. The associations of preeclampsia (hazard ratio=1.66 [95% CI, 1.14–2.42]) and severe preeclampsia (hazard ratio=2.01 [95% CI, 1.08–3.73]) were independent of all covariates. Maternal hypertensive and diabetes mellitus disorders and overweight/obesity also additively increased offspring hazard of mental disorders. Preterm and small-for-gestational-age births and neonatal intensive care unit admission partially mediated the effects of any and severe preeclampsia on offspring mental disorders. To conclude, maternal hypertensive pregnancy disorders carry adverse consequences for offspring mental health.
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Affiliation(s)
- Marius Lahti-Pulkkinen
- From the Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland (M.L.-P., P.G., S.T., S.S., J. Lahti, K.H., J. Lipsanen, H.L., K.R.)
- National Institute for Health and Welfare, Helsinki, Finland (M.L.-P., S.S., E.K.)
- University of Edinburgh, United Kingdom (M.L.-P., R.M.R.)
| | - Polina Girchenko
- From the Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland (M.L.-P., P.G., S.T., S.S., J. Lahti, K.H., J. Lipsanen, H.L., K.R.)
| | - Soile Tuovinen
- From the Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland (M.L.-P., P.G., S.T., S.S., J. Lahti, K.H., J. Lipsanen, H.L., K.R.)
| | - Sara Sammallahti
- From the Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland (M.L.-P., P.G., S.T., S.S., J. Lahti, K.H., J. Lipsanen, H.L., K.R.)
- National Institute for Health and Welfare, Helsinki, Finland (M.L.-P., S.S., E.K.)
- Erasmus Medical Center, Rotterdam, the Netherlands (S.S.)
| | | | - Jari Lahti
- From the Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland (M.L.-P., P.G., S.T., S.S., J. Lahti, K.H., J. Lipsanen, H.L., K.R.)
- University of Turku, Finland (J. Lahti)
| | - Kati Heinonen
- From the Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland (M.L.-P., P.G., S.T., S.S., J. Lahti, K.H., J. Lipsanen, H.L., K.R.)
| | - Jari Lipsanen
- From the Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland (M.L.-P., P.G., S.T., S.S., J. Lahti, K.H., J. Lipsanen, H.L., K.R.)
| | - Esa Hämäläinen
- University of Helsinki and Helsinki University Hospital, Finland (E.H., P.M.V., E.K., H.L.)
| | - Pia M. Villa
- University of Helsinki and Helsinki University Hospital, Finland (E.H., P.M.V., E.K., H.L.)
- Hyvinkää Hospital, Finland (P.M.V.)
| | - Eero Kajantie
- National Institute for Health and Welfare, Helsinki, Finland (M.L.-P., S.S., E.K.)
- University of Helsinki and Helsinki University Hospital, Finland (E.H., P.M.V., E.K., H.L.)
- Oulu University Hospital and University of Oulu, Finland (E.K.)
- Norwegian University for Science and Technology, Trondheim, Norway (E.K.)
| | - Hannele Laivuori
- From the Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland (M.L.-P., P.G., S.T., S.S., J. Lahti, K.H., J. Lipsanen, H.L., K.R.)
- University of Helsinki and Helsinki University Hospital, Finland (E.H., P.M.V., E.K., H.L.)
- University of Tampere, Finland (H.L.)
| | - Katri Räikkönen
- From the Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Finland (M.L.-P., P.G., S.T., S.S., J. Lahti, K.H., J. Lipsanen, H.L., K.R.)
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Wu MQ, Liu J, Wang YQ, Yang Y, Yan CH, Hua J. The Impact of Subclinical Hypothyroidism on Adverse Perinatal Outcomes and the Role of Thyroid Screening in Pregnancy. Front Endocrinol (Lausanne) 2019; 10:522. [PMID: 31447778 PMCID: PMC6691141 DOI: 10.3389/fendo.2019.00522] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022] Open
Abstract
Subclinical hypothyroidism (SCH) is a mild form of hypothyroidism that is common among women of childbearing age. The impact of SCH on adverse perinatal outcomes is unclear and universal screening for thyroid function before or during pregnancy is also much debated. In the present retrospective cohort study on 7,587 women from Shanghai, we assessed whether SCH was associated with adverse perinatal outcomes. The relationship between the risks of adverse outcomes and the time of screening and LT4 treatment status for SCH were also evaluated. SCH was associated with hypertensive disorders of pregnancy (HDP) [odds ratio (OR): 4.04; 95% confidence interval (CI): 1.85-8.84; P = 0.000]. After classification into four different groups based on the time of screening for thyroid function, the increased likelihood of HDP persisted in those diagnosed with SCH in the first and second trimesters (OR: 9.69; 95% CI: 1.73-54.48; P = 0.01 and OR: 3.66; 95% CI: 1.07-12.57, P = 0.03, respectively). The diagnosis of SCH in the preconception period and the third trimester was not significantly associated with HDP and other adverse perinatal outcomes. Five out of 120 (5/120) treated women (4.17%) vs. 4/45 untreated women (8.89%) developed HDP, 4/5 were treated after conception. The results indicate that during pregnancy, SCH conferred an increased risk of HDP, particularly in women diagnosed with the disorder in the first and second trimesters.
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Affiliation(s)
- Mei-Qin Wu
- MOE, Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Liu
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Ya-Qian Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Yang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chong-Huai Yan
- MOE, Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Chong-Huai Yan
| | - Jing Hua
- The Women and Children's Health Care Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- Jing Hua
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