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Peyronnet V, Le Faou AL, Berlin I. [Smoking cessation during pregnancy]. Rev Mal Respir 2024:S0761-8425(24)00236-5. [PMID: 39209565 DOI: 10.1016/j.rmr.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/07/2024] [Indexed: 09/04/2024]
Abstract
Smoking during pregnancy is associated with negative pregnancy and perinatal health outcomes. Physiological and societal particularities can modify the smoking behavior of pregnant women. Pregnancy is a teachable moment for smoking cessation. Increased nicotine clearance may lead to exacerbated tobacco withdrawal symptoms and desire to smoke, which need to be taken into account when helping pregnant smokers to quit. Although most pregnant smokers try to quit on their own, 12% of pregnant women in France reported smoking in 2021 during the 3rd trimester of pregnancy. Health care professionals should screen for tobacco consumption and assess the level of addiction. Management of smoking cessation can be multidisciplinary, including non-pharmacological support such as counselling, behavioral support, financial reward contingent on abstinence, and medication (nicotine replacement therapies). Assessment and limitation of secondhand smoke exposure (SHS) is needed because SHS can also have negative maternal and fetal consequences. Management of relapse during the postpartum period is also to be anticipated; in 2021, it concerned 22.4% of women who had stopped smoking during pregnancy. While electronic cigarette use is increasing overall and among pregnant women who smoke (5.4 before pregnancy, 1.3% during the 3rd trimester in 2021), well-conducted smoking cessation studies are necessary to assess its benefits and potential risks in this specific group of smokers.
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Affiliation(s)
- V Peyronnet
- Service de gynécologue-obstétrique, hôpital Louis-Mourier, AP-HP, Colombes, France.
| | - A-L Le Faou
- Centre ambulatoire d'addictologie, hôpital européen Georges-Pompidou, centre - université Paris-Cité, AP-HP, Paris, France
| | - I Berlin
- Département de pharmacologie médicale, hôpital Pitié-Salpêtrière, Sorbonne université, Paris, France
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Kurtoğlu A, Eken Ö, Türkmen M, Çar B, Setiawan E, Yermakhanov B, Alotaibi MH, Elkholi SM. Chronotype as a predictor of athletic performance in youth with mild intellectual disabilities. Front Physiol 2024; 15:1405595. [PMID: 39035451 PMCID: PMC11257919 DOI: 10.3389/fphys.2024.1405595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
Aim This study aimed to explore the influence of circadian rhythms on athletic performance in individuals with mild intellectual disabilities (ID), with a specific focus on elucidating the association between chronotype and various performance metrics. Methods The study was a cross-sectional study consisting of 30 male participants aged between 11 and 19 years and diagnosed with mild ID. The chronotypes of all participants were assessed using the Childhood Chronotype Questionnaire (CCQ). Performance assessments were divided into three groups. Group A tests [sit and reach, medicine ball throw (MBT), plank], group B tests [handgrip strength (HGS), standing long jump (SLJ), 20-m sprint (20 ms)] and group C tests [vertical jump (VJ), hanging with bent arm (HBA), Illinois agility test) in order to ensure adequate rest periods between tests and not to affect the results. These group tests were performed 48 h apart, between 09:00-10:00 and 17:00-18:00, after a dynamic warm-up session. Results Significant variations were observed in the sit-and-reach test (t = -4.154, d = -0.75, p < .001), HGS (t = -2.484, d = -0.45, p = .019), SLJ (t = -2.117, d = -0.38, p = .043), VJ (t = -5.004, d = -0.91, p < .001), and plank duration (t = -4.653, d = -0.84, p < .001). Evening performances showed improvement in MBT, HBA, 20 ms, and the Illinois agility test, although these differences were not statistically significant (p > .05). Notably, positive correlations were identified between participants' chronotypes and their performance in HBA (morning/evening; r = .693, p = .026; r = .656, p = .039, respectively) and the plank (evening; r = .717, p = .020), with negative correlations noted in the 20 ms (morning/evening; r = -.703, p = .023; r = -.710, p = .021, respectively). Conclusion The findings suggest that individuals with mild ID exhibit enhanced athletic performance during evening hours. These insights underscore the importance of considering chronotype in tailoring exercise interventions for this population to optimize outcomes.
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Affiliation(s)
- Ahmet Kurtoğlu
- Department of Coaching Education, Faculty of Sport Science, Bandirma Onyedi Eylul University, Balikesir, Türkiye
| | - Özgür Eken
- Department of Physical Education and Sport Teaching, Faculty of Sport Sciences, Inonu University, Malatya, Türkiye
| | - Musa Türkmen
- Department of Physical Education and Sport Teaching, Faculty of Sport Sciences, Inonu University, Malatya, Türkiye
| | - Bekir Çar
- Department of Physical Education and Sport Teaching, Faculty of Sport Sciences, Bandirma Onyedi Eylul University, Bandirma, Türkiye
| | - Edi Setiawan
- Faculty of Teacher Training and Education, Universitas Suryakancana, Cianjur, Indonesia
| | - Baglan Yermakhanov
- Faculty of Sports and Arts, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkestan, Kazakhstan
| | - Madawi H. Alotaibi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Safaa M. Elkholi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Madley-Dowd P, Thomas R, Boyd A, Zammit S, Heron J, Rai D. Maternal smoking during pregnancy and offspring risk of intellectual disability: a UK-based cohort study. Front Psychiatry 2024; 15:1352077. [PMID: 38983370 PMCID: PMC11232073 DOI: 10.3389/fpsyt.2024.1352077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/30/2024] [Indexed: 07/11/2024] Open
Abstract
Background Observational studies have described associations of maternal smoking during pregnancy with intellectual disability (ID) in the exposed offspring. Whether these results reflect a causal effect or unmeasured confounding is still unclear. Methods Using a UK-based prospectively collected birth cohort (the Avon Longitudinal Study of Parents and Children) of 13,479 children born between 1991 and 1992, we assessed the relationship between maternal smoking at 18 weeks' gestation and offspring risk of ID, ascertained through multiple sources of linked information including primary care diagnoses and education records. Using confounder-adjusted logistic regression, we performed observational analyses and a negative control analysis that compared maternal with partner smoking in pregnancy under the assumption that if a causal effect were to exist, maternal effect estimates would be of greater magnitude than estimates for partner smoking if the two exposures suffer from comparable biases. Results In observational analysis, we found an adjusted odds ratio for ID of 0.75 (95% CI = 0.49-1.13) for any maternal smoking and 0.97 (95% CI = 0.71-1.33) per 10-cigarette increase in number of cigarettes smoked per day. In negative control analysis, comparable effect estimates were found for any partner smoking (OR = 0.94; 95% CI = 0.63-1.40) and number of cigarettes smoked per day (OR = 0.94; 95% CI = 0.74-1.20). Conclusions The results are not consistent with a causal effect of maternal smoking during pregnancy on offspring ID.
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Affiliation(s)
- Paul Madley-Dowd
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service (NHS) Foundation Trust and University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
| | - Richard Thomas
- UK Longitudinal Linkage Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Andy Boyd
- UK Longitudinal Linkage Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Stanley Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service (NHS) Foundation Trust and University of Bristol, Bristol, United Kingdom
- Medical Research Council (MRC) Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service (NHS) Foundation Trust and University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Avon and Wiltshire Partnership NHS Mental Health Trust, Bath, United Kingdom
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Vankwani S, Mirza MR, Awan FR, Zafar M, Nawrocki A, Wasim M, Khan HN, Ayesha H, Larsen MR, Choudhary MI. Label free quantitative proteomic profiling of serum samples of intellectually disabled young patients revealed dysregulation of complement coagulation and cholesterol cascade systems. Metab Brain Dis 2024; 39:855-869. [PMID: 38733546 DOI: 10.1007/s11011-024-01351-6] [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: 09/16/2023] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
Intellectual disability is a heterogeneous disorder, diagnosed using intelligence quotient (IQ) score criteria. Currently, no specific clinical test is available to diagnose the disease and its subgroups due to inadequate understanding of the pathophysiology. Therefore, current study was designed to explore the molecular mechanisms involved in disease perturbation, and to identify potential biomarkers for disease diagnosis and prognosis. A total of 250 participants were enrolled in this study, including 200 intellectually disabled (ID) subjects from the subgroups (mild, moderate, and severe) with age and gender matched healthy controls (n = 50). Initially, IQ testing score and biochemical profile of each subject was generated, followed by label-free quantitative proteomics of subgroups of IQ and healthy control group through nano-LC/MS- mass spectrometry. A total of 310 proteins were identified, among them198 proteins were common among all groups. Statistical analysis (ANOVA) of the subgroups of ID showed 142 differentially expressed proteins, in comparison to healthy control group. From these, 120 proteins were found to be common among all subgroups. The remaining 22 proteins were categorized as exclusive proteins found only in disease subgroups. Furthermore, the hierarchical cluster analysis (HCL) of common significant proteins was also performed, followed by PANTHER protein classification and GO functional enrichment analysis. Results provides that the datasets of differentially expressed proteins, belong to the categories of immune / defense proteins, transfer carrier proteins, apolipoproteins, complement proteins, protease inhibitors, hemoglobin proteins etc., they are known to involvein immune system, and complement and coagulation pathway cascade and cholesterol metabolism pathway. Exclusively expressed 22 proteins were found to be disease stage specific and strong PPI network specifically those that have significant role in platelets activation and degranulation, such as Filamin A (FLNA). Furthermore, to validate the mass spectrometric findings, four highly significant proteins (APOA4, SAP, FLNA, and SERPING) were quantified by ELISA in all the study subjects. AUROC analysis showed a significant association of APOA4 (0.830), FLNA (0.958), SAP (0.754) and SERPING (0.600) with the disease. Apolipoprotein A4 (APOA4) has a significant role in cholesterol transport, and in modulation of glucose and lipid metabolism in the CNS. Similarly, FLNA has a crucial role in the nervous system, especially in the functioning of synaptic network. Therefore, both APOA4, and FLNA proteins represent good potential for candidate biomarkers for the diagnosis and prognosis of the intellectual disability. Overall, serum proteome of ID patients provides valuable information of proteins/pathways that are altered during ID progression.
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Affiliation(s)
- Soma Vankwani
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Munazza Raza Mirza
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan.
| | - Fazli Rabbi Awan
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Jhang Road, P.O. Box. 577, Faisalabad, Pakistan.
| | - Muneeza Zafar
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Jhang Road, P.O. Box. 577, Faisalabad, Pakistan
| | - Arkadiusz Nawrocki
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Muhammad Wasim
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Jhang Road, P.O. Box. 577, Faisalabad, Pakistan
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Haq Nawaz Khan
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Jhang Road, P.O. Box. 577, Faisalabad, Pakistan
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Hina Ayesha
- Department of Pediatrics, Punjab Medical College, Allied & DHQ Hospitals, Faisalabad Medical University, Faisalabad, Pakistan
| | - Martin Rossel Larsen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Muhammad Iqbal Choudhary
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
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Tsur N, Beer Z, Rittblat M, Yaacobi D, Elmograbi A, Reuven Y. Intelligence among ear deformities and cleft lip and/or alveolus and/or cleft palate patients during 50 years in Israel. Orthod Craniofac Res 2024; 27 Suppl 1:14-20. [PMID: 37650486 DOI: 10.1111/ocr.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE We evaluated hearing loss and general intelligence among persons with auricle anomalies and cleft lip and/or alveolus and/or cleft palate (CLAP). METHODS A nationwide cross-sectional study of data recorded during 1966-2019, as mandatory pre-military recruitment of individuals. RESULTS Of 3 182 892 adolescents, 548 were diagnosed with auricle anomalies and 2072 with CLAP. For the latter, the adjusted odds ratios for the low, low to medium and medium general intelligence categories compared to the highest category were 1.4 [95% CI 1.5-1.2], 1.2 [95% CI 1.4-1.1] and 1.1 [95% CI 1.2-0.9] respectively. The corresponding values for the auricle anomalies were not significant. CONCLUSIONS General intelligence was impaired among individuals with CLAP, but no significant correlation was found among individuals suffering from auricle anomalies.
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Affiliation(s)
- Nir Tsur
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Zivan Beer
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mor Rittblat
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yaacobi
- Department of Plastic Surgery and Burns, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Aiman Elmograbi
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yonatan Reuven
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Brown M, Linden M, Marsh L, Truesdale M, Sheerin F, McCormick F. The Experiences of Young People with Intellectual Disability, Parents and Professionals in Relationships and Sexuality Education Programmes: Findings from a Qualitative Study. Healthcare (Basel) 2024; 12:1105. [PMID: 38891180 PMCID: PMC11171975 DOI: 10.3390/healthcare12111105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
People with intellectual disability want friendships and meaningful relationships, and some want intimacy. However, the expression of sexuality is an area where potential freedoms are often limited and restricted compared to their peers. While some relationships and sexuality education programmes do exist for this population, most focus on knowledge acquisition regarding sexuality and sex but lack in their focus on relationships, informed choices and decision-making. The aim of this study was to identify good practices and methods of delivery in relationships and sexuality education for children and young people with intellectual disability. A qualitative design was undertaken. Information about our study was distributed to eight special schools in the UK. Semi-structured interviews and focus groups were employed for data collection. Data from 37 pupils with intellectual disability, 11 parents and 16 healthcare and other professionals were thematically analysed. Following data analysis, three themes emerged: (i) seeking and sharing information; (ii) protecting and keeping safe; and (iii) learning for the future. The findings highlight that pupils are keen to learn about life changes and societal influences and want reliable information. Parents and professionals recognise that children and young people with intellectual disability will develop into adults and may be vulnerable when they leave the security of the school setting. They recognise that children and young people need to know about socialising, puberty, consent and contraception. Evidence-based programmes should be designed with these stakeholders to ensure children and young people with intellectual disability receive developmentally appropriate information to make happy and safe decisions about their relationships.
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Affiliation(s)
- Michael Brown
- School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (M.L.); (L.M.); (F.M.)
| | - Mark Linden
- School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (M.L.); (L.M.); (F.M.)
| | - Lynne Marsh
- School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (M.L.); (L.M.); (F.M.)
| | - Maria Truesdale
- Scottish Learning Disability Observatory, University of Glasgow, Glasgow G12 0XH, UK;
| | - Fintan Sheerin
- School of Nursing and Midwifery, Trinity College Dublin, D02 PN40 Dublin, Ireland;
| | - Freda McCormick
- School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (M.L.); (L.M.); (F.M.)
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Deshmukh MN, Harjpal P. Integrated Physiotherapeutic Intervention for Rehabilitation of a Patient With Intellectual Disabilities: A Case Report. Cureus 2024; 16:e56476. [PMID: 38638736 PMCID: PMC11024875 DOI: 10.7759/cureus.56476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Intellectual disabilities (ID) encompass a broad spectrum of neurodevelopmental disorders marked by impairments in cognitive functioning and adaptive behavior. Accessing and benefiting from rehabilitation services pose significant challenges for individuals within this population. In this case study, the rehabilitation journey of a 44-year-old man with ID, emphasizes the tailored approach to his rehabilitation program. The primary objectives of the program were to augment the patient's functional capabilities, foster independence, and enhance his overall quality of life. The case highlights the significance of personalized, comprehensive rehabilitation strategies intricately tailored to address the distinct requirements of individuals with ID. The case study delineates a comprehensive rehabilitation regimen integrating physical therapy to address the multifaceted needs of individuals with varying degrees of disability. This inclusive approach represents a paradigm shift toward a multidisciplinary (physiotherapy along with general medical care, special education, vocational training, and community-based interventions) person-centered model of care. Through addressing the varied needs of individuals with ID, the rehabilitation plan endeavors to empower them to lead enriching, self-directed lives within their communities, thereby unlocking their complete potential. This case study stands as evidence of the profound impact of customized rehabilitation interventions in cultivating inclusivity and optimizing the well-being of individuals with ID.
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Affiliation(s)
- Mansi N Deshmukh
- Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Furnier SM, Gangnon R, Daniels JL, Ellis Weismer S, Nadler C, Pazol K, Reyes NM, Rosenberg S, Rubenstein E, Wiggins LD, Yeargin-Allsopp M, Durkin MS. Racial and ethnic disparities in the co-occurrence of intellectual disability and autism: Impact of incorporating measures of adaptive functioning. Autism Res 2024; 17:650-667. [PMID: 38415400 PMCID: PMC11151777 DOI: 10.1002/aur.3107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/27/2024] [Indexed: 02/29/2024]
Abstract
Intellectual disability (ID) commonly co-occurs in children with autism. Although diagnostic criteria for ID require impairments in both cognitive and adaptive functioning, most population-based estimates of the frequency of co-occurring ID in children with autism-including studies of racial and ethnic disparities in co-occurring autism and ID-base the definition of ID solely on cognitive scores. The goal of this analysis was to examine the effect of including both cognitive and adaptive behavior criteria on estimates of co-occurring ID in a well-characterized sample of 2- to 5-year-old children with autism. Participants included 3264 children with research or community diagnoses of autism enrolled in the population-based Study to Explore Early Development (SEED) phases 1-3. Based only on Mullen Scales of Early Learning (MSEL) composite cognitive scores, 62.9% (95% confidence interval [CI]: 61.1, 64.7%) of children with autism were estimated to have co-occurring ID. After incorporating Vineland Adaptive Behavior Scales, Second Edition (VABS-II) composite or domains criteria, co-occurring ID estimates were reduced to 38.0% (95% CI: 36.2, 39.8%) and 45.0% (95% CI: 43.1, 46.9%), respectively. The increased odds of meeting ID criteria observed for non-Hispanic (NH) Black and Hispanic children relative to NH White children when only MSEL criteria were used were substantially reduced, though not eliminated, after incorporating VABS-II criteria and adjusting for selected socioeconomic variables. This study provides evidence for the importance of considering adaptive behavior as well as socioeconomic disadvantage when describing racial and ethnic disparities in co-occurring ID in epidemiologic studies of autism.
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Affiliation(s)
- Sarah M. Furnier
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ronald Gangnon
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Julie L. Daniels
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Susan Ellis Weismer
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Cy Nadler
- Division of Developmental and Behavioral Health, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Karen Pazol
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nuri M. Reyes
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Steven Rosenberg
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Lisa D. Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maureen S. Durkin
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Martinez D, Jiang E, Zhou Z. Overcoming genetic and cellular complexity to study the pathophysiology of X-linked intellectual disabilities. J Neurodev Disord 2024; 16:5. [PMID: 38424476 PMCID: PMC10902969 DOI: 10.1186/s11689-024-09517-0] [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: 12/17/2023] [Accepted: 02/04/2024] [Indexed: 03/02/2024] Open
Abstract
X-linked genetic causes of intellectual disability (ID) account for a substantial proportion of cases and remain poorly understood, in part due to the heterogeneous expression of X-linked genes in females. This is because most genes on the X chromosome are subject to random X chromosome inactivation (XCI) during early embryonic development, which results in a mosaic pattern of gene expression for a given X-linked mutant allele. This mosaic expression produces substantial complexity, especially when attempting to study the already complicated neural circuits that underly behavior, thus impeding the understanding of disease-related pathophysiology and the development of therapeutics. Here, we review a few selected X-linked forms of ID that predominantly affect heterozygous females and the current obstacles for developing effective therapies for such disorders. We also propose a genetic strategy to overcome the complexity presented by mosaicism in heterozygous females and highlight specific tools for studying synaptic and circuit mechanisms, many of which could be shared across multiple forms of intellectual disability.
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Affiliation(s)
- Dayne Martinez
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19102, USA
- Medical Scientist Training Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19102, USA
| | - Evan Jiang
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19102, USA
- Medical Scientist Training Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19102, USA
| | - Zhaolan Zhou
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19102, USA.
- Medical Scientist Training Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19102, USA.
- Department of Neuroscience, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19102, USA.
- Intellectual and Developmental Disabilities Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
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Grineski SE, Renteria RA, Collins TW, Bakian AV, Bilder D, VanDerslice JA, Fraser A, Gomez J, Ramos KD. PM 2.5 threshold exceedances during the prenatal period and risk of intellectual disability. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024:10.1038/s41370-024-00647-0. [PMID: 38388655 DOI: 10.1038/s41370-024-00647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Research demonstrates that chronic exposure to fine particulates (PM2.5) increases risks of neurodevelopmental conditions, such as intellectual disability (ID). Few studies have examined neurodevelopmental health impacts of pollution spikes exceeding 24-h (24-h) PM2.5 guidelines, despite relevance to the regulatory landscape. The current potential for regulatory changes to 24-h PM2.5 standards in the United States makes research on exceedances relevant. OBJECTIVE To examine associations between 24-h PM2.5 exceedances and the risk of ID. METHODS We conducted a retrospective case-control study of a sample of children in Utah, USA. We used generalized estimating equations to predict odds of ID based on the number of 24-h PM2.5 exceedance days during the preconception period and three trimesters of pregnancy. Exceedance days are defined as per current World Health Organization (WHO) [≥15 μg/m3] and current US Environmental Protection Agency (EPA) [≥35 μg/m3] 24-h guidelines. RESULTS PM2.5 exceedances are associated with ID risk during the preconception and first trimester periods and not the second and third trimesters. During the preconception period, each day exceeding 15 μg/m3 or 35 μg/m3 was associated with a 1.023 (CI: 1.011-1.040) or 1.042 (CI: 1.026-1.059, p < 0.001) increase in odds of ID, respectively. During the first trimester, each day exceeding 15 μg/m3 or 35 μg/m3 was associated with a 1.032 (CI: 1.017-1.047) or 1.059 (CI: 1.030-1.088) increase in odds of ID, respectively. IMPACT STATEMENT Potential regulatory movement on the US 24-h PM2.5 standard makes research that explicitly studies exceedances highly relevant. Yet few studies examine health effects of exceeding 24-h guidelines for any air pollutants. This study fills important gaps in the literature by examining associations between odds of intellectual disability and the count of days exceeding current 24-h PM2.5 guidelines, as established by the World Health Organization and US Environmental Protection Agency, during the prenatal period. We find that exceedances of both sets of guidelines, during the preconception and first trimester periods, are associated with ID risk.
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Affiliation(s)
- Sara E Grineski
- Department of Sociology, University of Utah, 380 S. 1530 E., Rm. 301, Salt Lake City, UT, 84112, USA.
| | - Roger A Renteria
- Department of Sociology, University of Utah, 380 S. 1530 E., Rm. 301, Salt Lake City, UT, 84112, USA
| | - Timothy W Collins
- Department of Geography, University of Utah, 260 Central Campus Dr., Rm. 4728, Salt Lake City, UT, 84112, USA
| | - Amanda V Bakian
- Department of Psychiatry, University of Utah School of Medicine, 30 N. 1900 E., Salt Lake City, UT, 84132, USA
| | - Deborah Bilder
- Department of Psychiatry, University of Utah School of Medicine, 30 N. 1900 E., Salt Lake City, UT, 84132, USA
| | - James A VanDerslice
- Department of Family and Preventative Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste. A, Salt Lake City, UT, 84108, USA
| | - Alison Fraser
- Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr Ste 1950, Salt Lake City, UT, 84112, USA
| | - Jaqueline Gomez
- Environmental and Sustainability Studies Program, University of Utah, 260 S Central Campus Drive, Room 4540, Salt Lake City, UT, 84112, USA
| | - Kevin D Ramos
- Department of Geography, University of Utah, 260 Central Campus Dr., Rm. 4728, Salt Lake City, UT, 84112, USA
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Persson M, Tedroff K, Yin W, Andersson Franko M, Sandin S. Maternal type 1 diabetes, preterm birth, and risk of intellectual disability in the offspring: A nation-wide study in Sweden. Eur Psychiatry 2024; 67:e11. [PMID: 38251044 DOI: 10.1192/j.eurpsy.2024.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE There are few data on long-term neurological or cognitive outcomes in the offspring of mothers with type 1 diabetes (T1D). The aims of this study were to examine if maternal T1D increases the risk of intellectual disability (ID) in the offspring, estimate the amount of mediation through preterm birth, and examine if the association was modified by maternal glycated hemoglobin (HbA1c). DESIGN Population-based cohort study using population-based data from several national registries in Sweden. SETTING AND PARTICIPANTS All offspring born alive in Sweden between the years 1998 and 2015. MAIN OUTCOME MEASURE The risk of ID was estimated through hazard ratios with 95% confidence intervals (HR, 95% CI) from Cox proportional hazard models, adjusting for potential confounding. Risks were also assessed in mediation analyses and in subgroups of term/preterm births, in relation to maternal HbA1c and by severity of ID. RESULTS In total, 1,406,441 offspring were included. In this cohort, 7,794 (0.57%) offspring were born to mothers with T1D. The risk of ID was increased in offspring of mothers with T1D (HR; 1.77, 1.43-2.20), of which 47% (95% CI: 34-100) was mediated through preterm birth. The HRs were not modified by HbA1c. CONCLUSION T1D in pregnancy is associated with moderately increased risks of ID in the offspring. The risk is largely mediated by preterm birth, in particular for moderate/severe cases of ID. There was no support for risk-modification by maternal HbA1c.
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Affiliation(s)
- Martina Persson
- Department of Clinical Science and Education, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
- Sachsska Children's and Youth Hospital, Stockholm, Sweden
| | - Kristina Tedroff
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Weiyao Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Andersson Franko
- Department of Clinical Science and Education, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment at Mount Sinai, New York, NY, USA
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12
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Chen S, Ahlqvist VH, Sjöqvist H, Stephansson O, Magnusson C, Dalman C, Karlsson H, Lee BK, Gardner RM. Maternal intrahepatic cholestasis of pregnancy and neurodevelopmental conditions in offspring: A population-based cohort study of 2 million Swedish children. PLoS Med 2024; 21:e1004331. [PMID: 38227577 PMCID: PMC10790993 DOI: 10.1371/journal.pmed.1004331] [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: 07/11/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is the most common obstetric liver disorder and is associated with an increased risk of iatrogenic preterm birth and adverse infant outcomes. Hence, there are several plausible pathways through which ICP could affect offspring neurodevelopment. However, to the best of our knowledge, no studies have investigated these associations. Thus, we aimed to determine whether ICP is associated with offspring neurodevelopmental conditions. METHODS AND FINDINGS In this Swedish register-based cohort study, we included singleton non-adopted children born in Sweden between the 1st of January 1987 and the 31st of December 2010, who were resident in Sweden >5 years, with no missing covariate information, which we followed until the 31st of December 2016. Maternal ICP diagnosis and the date of the initial diagnosis during pregnancy were obtained from the National Patient Register. Offspring diagnoses of attention deficit/hyperactivity disorder (ADHD), autism, or intellectual disability were obtained from the National Patient Register, and the dispensation of ADHD medications were obtained from the Prescribed Drug Register. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression while controlling for observed confounders and unobserved confounders shared among full siblings and maternal full cousins. A total of 2,375,856 children were included in the study; 81.6% of them were of Nordic origin, and 51.4% were male. Of these, 10,378 (0.44%) were exposed to ICP. During a median of 18 years follow-up (interquartile range 11 to 24), 143,746 (6.05%) of children were diagnosed with a neurodevelopmental condition. After adjusting for child's sex, birth year, birth month, maternal age, highest parental education level, maternal birth country, birth order, maternal psychiatric history, ICP was associated with increased odds of offspring neurodevelopmental conditions (OR 1.22, 95% CI 1.13 to 1.31), particularly among those exposed to early-onset ICP (OR 2.38, 95% CI 1.71 to 3.30) as compared to ICP diagnosed after reaching term (≥37 weeks of gestation) (OR 1.08, 95% CI 0.97 to 1.20). The findings of early-onset ICP were consistent in family-based analyses. Within-family comparisons of full maternal cousins yielded an OR of 2.99 (95% CI 1.48 to 6.04), and comparisons of full siblings showed an OR of 1.92 (95% CI 0.92 to 4.02), though the latter was less precise. The findings were consistent across specific neurodevelopmental conditions and different analytical approaches. The primary limitations of this study included its observational design, the absence of data on ICP therapeutics, and the lack of bile acid measures. CONCLUSIONS In this study, we observed that exposure to ICP during gestation is associated with an increased likelihood of neurodevelopmental conditions in offspring, particularly in cases of early-onset ICP. Further studies are warranted to better understand the role of early-ICP in offspring neurodevelopment.
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Affiliation(s)
- Shuyun Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Viktor H. Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Sjöqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Håkan Karlsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brian K. Lee
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, United States of America
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, United States of America
| | - Renee M. Gardner
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Chen S, Wang X, Lee BK, Gardner RM. Associations between maternal metabolic conditions and neurodevelopmental conditions in offspring: the mediating effects of obstetric and neonatal complications. BMC Med 2023; 21:422. [PMID: 37936224 PMCID: PMC10631144 DOI: 10.1186/s12916-023-03116-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Maternal pre-gestational diabetes (PGDM), gestational diabetes mellitus (GDM), and overweight/obesity have been associated with increased risks of offspring neurodevelopmental conditions (NDCs) including autism, intellectual disability (ID), and attention deficit/hyperactivity disorder (ADHD). Less is known about whether and how obstetric and neonatal complications (e.g., preterm birth, neonatal asphyxia) could mediate these associations. METHODS In this Swedish register-based cohort study, we examined complications during pregnancy, delivery, and the neonatal period as potential mediators of the relationships between maternal metabolic conditions and offspring NDCs. We quantified the extent to which these obstetric and neonatal factors could mediate the associations of maternal metabolic conditions with offspring NDCs by applying parametric regression models for single mediation analyses and weighting-based methods for multiple mediation analyses under counterfactual frameworks. RESULTS The study sample included 2,352,969 singleton children born to 1,299,692 mothers from 1987-2010 who were followed up until December 31, 2016, of whom 135,832 children (5.8%) were diagnosed with at least one NDC. A substantial portion of the association between maternal PGDM and children's odds of NDCs could be explained by the combined group of obstetric and neonatal complications in the multiple mediation analysis. For instance, these complications explained 44.4% of the relationship between maternal PGDM and offspring ID risk. The proportion of the relationship between maternal overweight/obesity and children's risk of NDCs that could be explained by obstetric and neonatal complications was considerably smaller, ranging from 1.5 to 8.1%. Some complications considered on their own, including pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities, could explain at least 10% of the associations between maternal PGDM and offspring NDCs. Complications during the neonatal period showed a stronger joint mediating effect for the relationship between PGDM and offspring NDCs than those during pregnancy or delivery. CONCLUSIONS Obstetric and neonatal complications could explain nearly half of the association between maternal PGDM and offspring risk of NDCs. The mediating effects were more pronounced for complications during the neonatal period and for specific complications such as pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities. Effective preventive strategies for offspring NDCs should holistically address both the primary metabolic issues related to PGDM and the wide array of potential complications, especially those in the neonatal period.
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Affiliation(s)
- Shuyun Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Xi Wang
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian K Lee
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA
- A.J. Drexel Autism Institute, Philadelphia, PA, USA
| | - Renee M Gardner
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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Malhotra A, Drexler K, Hsu M, Tang YL. Medication treatment for alcohol use disorder in special populations. Am J Addict 2023; 32:433-441. [PMID: 37551638 DOI: 10.1111/ajad.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/28/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Alcohol use disorder (AUD) is a significant public health concern, with underutilized effective treatments, particularly in special populations. This article summarizes the current evidence and guidelines for treating AUD in special populations. METHODS This article is a literature review that synthesizes the latest research on AUD treatment for special populations. We screened 242 articles and included 57 in our final review. RESULTS There are four food and Drug Administration-approved medications for AUD (MAUD): disulfiram, oral naltrexone, extended-release injectable naltrexone (XR-NTX), and acamprosate. Naltrexone and disulfiram have the potential to cause liver toxicity, and acamprosate should be avoided in patients with severe kidney disease. Psychosocial treatments should be considered first-line for pregnant and nursing patients. Naltrexone is contraindicated in patients on opioids, as it may precipitate acute withdrawal. For patients experiencing homelessness, nonabstinent treatment goals may be more practical, and XR-NTX should be considered to improve adherence. Limited evidence suggests medication can improve AUD treatment outcomes in adolescents and young adults. For patients with poor treatment response despite adequate medication adherence, switching to a different medication and augmentation with psychosocial treatments should be considered. DISCUSSION AND CONCLUSIONS Understanding the unique considerations for special populations with AUD is crucial, and addressing their special needs may improve their treatment outcomes. SCIENTIFIC SIGNIFICANCE Our study significantly contributes to the existing literature by summarizing crucial information for the treatment of AUD in special populations, highlighting distinct challenges, and emphasizing tailored approaches to improve overall health and well-being.
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Affiliation(s)
- Aniket Malhotra
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Karen Drexler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Michael Hsu
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
- Substance Abuse Treatment Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, Georgia, USA
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15
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Chen S, Persson M, Wang R, Dalman C, Lee BK, Karlsson H, Gardner RM. Random capillary glucose levels throughout pregnancy, obstetric and neonatal outcomes, and long-term neurodevelopmental conditions in children: a group-based trajectory analysis. BMC Med 2023; 21:260. [PMID: 37468907 DOI: 10.1186/s12916-023-02926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/06/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with both short- and long-term risks, although it is unknown if risks vary by severity, timing, and duration of gestational hyperglycemia. We aimed to identify trajectories of random capillary glucose (RCG) levels throughout pregnancy and assess their associations with both obstetric/neonatal outcomes and children's risk of neurodevelopmental conditions (NDCs) (i.e., autism, intellectual disability, and attention-deficit/hyperactivity disorders [ADHD]). METHODS A population-based cohort study was conducted involving 76,228 children born to 68,768 mothers without pregestational diabetes. Group-based trajectory modeling was utilized to identify distinct glucose trajectories across RCG values throughout the course of pregnancy. The associations between these trajectory groups and obstetric/neonatal outcomes as well as children's NDCs were then assessed using generalized estimating equation models with a logit link. The Benjamini-Hochberg (BH) procedure was employed to adjust P-values for multiple comparisons, controlling the false discovery rate (FDR). RESULTS Five distinct glucose trajectory groups were identified, each with varying percentages diagnosed with GDM. Their associations with obstetric/neonatal outcomes as well as children's NDCs varied. For example, when compared to the "Persistently Low" group, other groups exhibited varying degrees of increased risk for large-for-gestational-age babies, with the exception of the "High in Early Pregnancy" group. Compared to the "Persistently Low" group, all other trajectory groups were associated with NDC outcomes, except the "High in Mid-Pregnancy" group. However, none of the associations with offspring NDCs remained significant after accounting for the FDR correction. CONCLUSIONS Persistent high glucose levels or moderately elevated glucose levels throughout pregnancy, as well as transient states of hyperglycemia in early or mid-pregnancy, were found to be associated with increased risks of specific obstetric and neonatal complications, and potentially offspring NDCs. These risks varied depending on the severity, timing, duration, and management of hyperglycemia. The findings underscore the need for continuous surveillance and individualized management strategies for women displaying different glucose trajectories during pregnancy. Limitations such as potential residual confounding, the role of mediators, and small sample size should be addressed in future studies.
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Affiliation(s)
- Shuyun Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Rui Wang
- The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Brian K Lee
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA
- A.J. Drexel Autism Institute, Philadelphia, PA, USA
| | - Håkan Karlsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Renee M Gardner
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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16
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Jansson AK, Söderling J, Reutfors J, Thor A, Sköld C, Cohn-Cedermark G, Ståhl O, Smedby KE, Pettersson A, Glimelius I. Risk and mortality of testicular cancer in patients with neurodevelopmental or other psychiatric disorders. Br J Cancer 2023; 128:2261-2269. [PMID: 37088800 PMCID: PMC10241835 DOI: 10.1038/s41416-023-02260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Both testicular germ cell tumours (TGCT) and neurodevelopmental disorders are associated with urogenital malformations. Few studies have investigated the association between psychiatric disorders and TGCT. We investigated whether history of any psychiatric or neurodevelopmental disorder is associated with increased risk or mortality of TGCT. METHOD This is a nested case-control study including 6166 TGCT patients diagnosed during 1992-2014, individually matched for age and calendar period to 61,660 controls. We calculated odds ratios (ORs) for the association between type of psychiatric diagnoses and TGCT risk. Among the cases, we used a cohort design and calculated hazard ratios (HRs) of the association between psychiatric diagnose and all-cause and TGCT-specific death. RESULTS History of a neurodevelopmental disorder (attention deficit hyperactivity disorder, autism spectrum disorder and intellectual disabilities) was associated with an increased risk of seminoma (OR: 1.54; 1.09-2.19). Seminoma patients with neurodevelopmental disorders were younger (34 versus 38 years, p = 0.004) and had more stage IV disease (5.4% versus 1.2%) than those without. Psychiatric history overall was not associated with TGCT. Patient history of any psychiatric disorder was associated with an increased all-cause and TGCT-specific death. CONCLUSIONS We report an association between neurodevelopmental disorders and testicular seminoma, and an increased TGCT-specific mortality for TGCT patients with psychiatric disorders.
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Affiliation(s)
- Anna K Jansson
- Department of Immunology, Genetics & Pathology, Uppsala University, Uppsala, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Reutfors
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anna Thor
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Sköld
- Department of Immunology, Genetics & Pathology, Uppsala University, Uppsala, Sweden
| | - Gabriella Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Genitourinary Oncology Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Pettersson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics & Pathology, Uppsala University, Uppsala, Sweden.
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Chowdhury MAK, Hardin JW, Love BL, Merchant AT, McDermott S. Relationship of Nonsteroidal Anti-Inflammatory Drug Use During Pregnancy with Autism Spectrum Disorder and Intellectual Disability Among Offspring. J Womens Health (Larchmt) 2023; 32:356-365. [PMID: 36576852 DOI: 10.1089/jwh.2022.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: This study aimed to examine the association of nonsteroidal anti-inflammatory drug (NSAID) use by pregnant women during pregnancy with autism spectrum disorder (ASD) and intellectual disability (ID) in their children among Medicaid-insured mother-child dyads. Materials and Methods: We conducted a retrospective cohort study linking multiple datasets of South Carolina for the years between 2010 and 2017, in which the main exposure variable was NSAID use during pregnancy and outcome variables were ASD only, ID only, and ASD with ID. We conducted a multinomial logistic regression analysis, controlling for identified risk factors for ASD (mother's age, race, body-mass index, preeclampsia, and gestational diabetes). Results: NSAID use during pregnancy was found to be associated with ID only in both unadjusted and adjusted analyses. Children with mothers who had NSAID prescriptions were 26% more likely to have ID in comparison with children whose mothers did not have NSAID prescriptions (odds ratio: 1.26 [1.10-1.46]). The other risk factors identified for ASD were maternal age, race, preeclampsia, smoking, low birth weight, and obesity. For ID, the risk factors were maternal age, race, smoking, birth weight, overweight, and obesity, all of which were also associated with ASD with ID, except for overweight. Conclusions: NSAID usage during pregnancy was found to be associated with ID only and not with ASD. However, more research is needed to validate the effect of NSAIDs during pregnancy on ASD and ID among children.
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Affiliation(s)
| | - James W Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bryan L Love
- Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Suzanne McDermott
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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Newborn Auditory Brainstem Responses in Children with Developmental Disabilities. J Autism Dev Disord 2023; 53:776-788. [PMID: 34181140 PMCID: PMC9549590 DOI: 10.1007/s10803-021-05126-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/30/2022]
Abstract
We integrated data from a newborn hearing screening database and a preschool disability database to examine the relationship between newborn click evoked auditory brainstem responses (ABRs) and developmental disabilities. This sample included children with developmental delay (n = 2992), speech impairment (SI, n = 905), language impairment (n = 566), autism spectrum disorder (ASD, n = 370), and comparison children (n = 128,181). We compared the phase of the ABR waveform, a measure of sound processing latency, across groups. Children with SI and children with ASD had greater newborn ABR phase values than both the comparison group and the developmental delay group. Newborns later diagnosed with SI or ASD have slower neurological responses to auditory stimuli, suggesting sensory differences at birth.
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Grineski S, Alexander C, Renteria R, Collins TW, Bilder D, VanDerslice J, Bakian A. Trimester-specific ambient PM 2.5 exposures and risk of intellectual disability in Utah. ENVIRONMENTAL RESEARCH 2023; 218:115009. [PMID: 36495968 PMCID: PMC9845186 DOI: 10.1016/j.envres.2022.115009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Prenatal fine particulate matter (PM2.5) exposure is an understudied risk factor for neurodevelopmental outcomes, including intellectual disability (ID). Associations among prenatal exposures and neurodevelopmental outcomes may vary depending on the timing of exposure. Limited numbers of studies examining PM2.5 and neurodevelopmental outcomes have considered exposures occurring during the preconception period. To address these gaps, we conducted a case-control study of children born in Utah between 2002 and 2008 (n = 1032). Cases were identified using methods developed by the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network and matched with controls on birth year, sex, and birth county. We estimated the daily average PM2.5 concentration during a period spanning 12 weeks before the estimated conception date, as well as during each of the three trimesters at the maternal residential address listed on the child's birth certificate. In a multivariable model, the third (OR: 2.119, CI: 1.123-3.998, p = .021) and fourth (OR: 2.631, CI: 1.750-3.956, p < .001) quartiles for preconception average PM2.5 demonstrated significantly increased risk of ID relative to the first quartile. Second quartile preconception exposure was also associated with increased risk, though it did not reach significance (OR: 1.385, CI: 0.979-1.959, p = .07). The fourth quartile of first trimester average PM2.5 was positive and significant (OR: 2.278, CI: 1.522-3.411, p < .001); the third quartile was positive, but not significant (OR: 1.159, CI: 0.870-1.544, p = .312). Quartiles of second and third trimester were not associated with higher risk of ID. These findings from Utah, which were robust to a variety of sensitivity analyses, provide initial evidence that preconception and prenatal PM2.5 exposure may be associated with ID. Future studies are needed across other geographic locations and populations.
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Using Latent Profile Analysis to Identify Associations Between Gestational Chemical Mixtures and Child Neurodevelopment. Epidemiology 2023; 34:45-55. [PMID: 36166205 DOI: 10.1097/ede.0000000000001554] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Unsupervised machine learning techniques have become increasingly popular for studying associations between gestational exposure mixtures and human health. Latent profile analysis is one method that has not been fully explored. METHODS We estimated associations between gestational chemical mixtures and child neurodevelopment using latent profile analysis. Using data from the Maternal-Infant Research on Environmental Chemicals (MIREC) research platform, a longitudinal cohort of pregnant Canadian women and their children, we generated latent profiles from 27 gestational exposure biomarkers. We then examined the associations between these profiles and child Verbal IQ, Performance IQ, and Full-Scale IQ, measured with the Wechsler Preschool and Primary Scale of Intelligence, Third Edition (WPPSI-III). We validated our findings using k-means clustering. RESULTS Latent profile analysis detected five latent profiles of exposure: a reference profile containing 61% of the study participants, a high monoethyl phthalate (MEP) profile with moderately low persistent organic pollutants (POPs) containing 26%, a high POP profile containing 6%, a low POP profile containing 4%, and a smoking chemicals profile containing 3%. We observed negative associations between both the smoking chemicals and high MEP profiles and all IQ scores and between the high POP profile and Full-Scale and Verbal IQ scores. We also found a positive association between the low POP profile and Full-Scale and Performance IQ scores. All associations had wide 95% confidence intervals. CONCLUSIONS Latent profile analysis is a promising technique for identifying patterns of chemical exposure and is worthy of further study for its use in examining complicated exposure mixtures.
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Prevalence of Child Functional Difficulties and Its Associated Factors in Bangladesh: An Application of Count Regression Model. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6328522. [PMID: 36605102 PMCID: PMC9810413 DOI: 10.1155/2022/6328522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
Children that are mentally and physically healthy have a higher quality of life and are better able to function in their daily lives. Therefore, this study is aimed at investigating associated factors causing functional difficulties in male and female children ages 5-17 years. This study used data from a nationally representative cross-sectional household survey named the Multiple Indicator Cluster Survey (MICS) Bangladesh 2019. A total of 58,746 children aged 5-17 were selected for the study, where 30,300 children were male, and 28,446 were female. To deal with overdispersed count data, the study used a negative binomial regression model to find the associated factors. The results show that 39.3% of the male children and 40.9% of the female children were from the age group of 10-14. Educated children had a lower risk of dysfunction. Among male children, women with a total number of children ever born of 4 or more were 1.21 times (incidence rate ratios (IRR) = 1.21) more likely to have a dysfunctional child. Children of dysfunctional mothers are more likely to be dysfunctional themselves. The incidence rate ratio for children functional difficulty among Muslim girls was 36 percent higher than non-Muslim girls in Bangladesh. When compared to the Barisal Division, female children in the Mymensingh Division had a 16% higher risk of functional problems. Based on the findings, the Bangladesh government and other development partners should initiate policies and programs to minimize the impact of functional dysfunction in children.
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22
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Significant regional inequalities in the prevalence of intellectual disability and trends from 1990 to 2019: a systematic analysis of GBD 2019. Epidemiol Psychiatr Sci 2022; 31:e91. [PMID: 36539341 PMCID: PMC9805697 DOI: 10.1017/s2045796022000701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS Policymakers and researchers have little evidence on prevalence rates of intellectual disability (ID) or their changes over time to tailor healthcare interventions. Prevalence rates and trends of ID are especially lacking in regions with lower socio-demographic development. Additionally, the assessment of inequalities in the prevalence of ID across regions with varying socio-demographic development is understudied. This study assessed variations in prevalence rates of ID from 1990 to 2019 and the related inequalities between low and high socio-demographic index (SDI) regions. METHODS This study used global data from 1990 to 2019 for individuals with ID from the 2019 Global Burden of Diseases study. Data analyses were performed from September 2021 to January 2022. Prevalence for individuals with ID was extracted by sex, age groups and SDI regions. Annual percentage change (APC) was estimated for each demographic group within SDI regions to assess their prevalence trends over 30 years. Relative and absolute inequalities were calculated between low and high SDI regions for the various age groups. RESULTS In 2019, there were 107.62 million (1.74%) individuals with ID, with an APC of -0.80 (-0.88 to -0.72). There was a slightly higher prevalence among males (1.42%) than females (1.37%). The highest prevalence rates were found in the low-middle SDI regions (2.42%) and the lowest prevalence rates were in the high SDI regions (0.33%). There was a large reduction in the prevalence rate between the youngest age group v. the oldest age group in all the SDI regions and at all time points. The relative inequalities between low and high SDI regions increased over three decades. CONCLUSIONS While an overall decrease in global prevalence rate for ID was found, relative inequalities continue to increase with lower SDI regions needing more comprehensive support services. The demographic trends indicate a significantly higher mortality rate among those with ID v. the rest of the population. Our study highlights the necessity for policies and interventions targeting lower SDI regions to mobilise resources that better support individuals with ID and achieve sustainable development goals proposed by the United Nations.
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Adaptive Behavior in Slovak Children with Intellectual Disability in Institutional Care. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121911. [PMID: 36553354 PMCID: PMC9777255 DOI: 10.3390/children9121911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
This study aimed to analyze the adaptive skills of children with intellectual disabilities in institutional care. We focused on communication, socialization, daily living skills and their relationship with risk factors, and institutional care. Our sample included 197 children aged 5−18 years (M = 12.8, SD = 2.97), 50% boys, with IQ < 85 placed in different types and lengths of stay in institutional care. There were 17% that presented with borderline intellectual functioning (IQ 84−87) and 83% that had intellect disabilities. Adaptive behavior (AB) was assessed by Vineland Adaptive Behavior Scale (VABS-3). The BIF and Mild ID groups did not differ in Socialization. The profile of adaptive behavior for BIF and Mild ID was Daily Living Skills > Communication > Socialization, and for Moderate and Severe ID, Socialization > Daily Living Skills > Communication. Longer institutional care was associated with lower competencies in AB. Gender differences were found, females overperformed males in Socialization, Daily Living Skills, and ABC score. Levels of ID, gender, length of stay in institutional care, and neonatal difficulties were significant predictors in the model which explain the 63% variance of AB. The practical implications of the results are discussed related to the assessment of ID, prevention, and care for institutionalized children.
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Vostrý M, Lanková B, Pešatová I, Müllerová L, Vomáčková H. Assessment of the Functional Level of Independence in Individuals with Mental Disabilities as Part of Special Education Diagnostics: Case Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15474. [PMID: 36497547 PMCID: PMC9739072 DOI: 10.3390/ijerph192315474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
In this study we focus on the application of standardized tests aimed at evaluating the functional degree of independence in children (client 1, WeeFIM test; and client 2, FIM test) in special education diagnostics. The target group consisted of two clients with a diagnosis of mental functional diversity (n = 2; client 1: mild mental retardation, according to ICD-10: F70, aged 6.5 years; and client 2: moderate mental retardation, according to ICD-10: F71, aged 13.4 years). Special pedagogical intervention was primarily applied to the clients, focusing on identified deficits in the areas of cognitive, motor, and social skills. The presented results demonstrate the importance of the application of these tests in special pedagogy. An improvement in the observed indicators of the given tests was demonstrated for both probands after the intervention. The aim of this article was to draw attention to the suitability of using functional independence tests in special pedagogical practices. The authors discuss the further implications of this application for future practice.
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Affiliation(s)
- Michal Vostrý
- Research Centre, Faculty of Health Studies, Jan Evangelista Purkyně University in Ústí nad Labem, 400 96 Ústí nad Labem, Czech Republic
- Department of Special and Social Education, Faculty of Education, Jan Evangelista Purkyně University in Ústí nad Labem, 400 96 Ústí nad Labem, Czech Republic
| | - Barbora Lanková
- Department of Primary and Pre-Primary Education, Faculty of Education, Jan Evangelista Purkyně University in Ústí nad Labem, 400 96 Ústí nad Labem, Czech Republic
| | - Ilona Pešatová
- Department of Special and Social Education, Faculty of Education, Jan Evangelista Purkyně University in Ústí nad Labem, 400 96 Ústí nad Labem, Czech Republic
| | - Lenka Müllerová
- Department of Special and Social Education, Faculty of Education, Jan Evangelista Purkyně University in Ústí nad Labem, 400 96 Ústí nad Labem, Czech Republic
| | - Helena Vomáčková
- Department of Special and Social Education, Faculty of Education, Jan Evangelista Purkyně University in Ústí nad Labem, 400 96 Ústí nad Labem, Czech Republic
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Tan GKY, Symons M, Fitzpatrick J, Connor SG, Cross D, Pestell CF. Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia. BMC Pediatr 2022; 22:587. [PMID: 36217109 PMCID: PMC9549627 DOI: 10.1186/s12887-022-03654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with Fetal Alcohol Spectrum Disorder (FASD) are at risk of having adverse childhood experiences (ACEs), especially those with child protection and/or justice system involvement. The complex relationship between FASD and psychosocial vulnerabilities in the affected individual is an important clinical risk factor for comorbidity. This study (1) explored the ACEs and associated stressors in individuals with FASD; (2) investigated the association between ACEs and negative outcomes, i.e., justice/child protection system involvement; and (3) examined the relationship between ACEs and comorbid conditions such as mood and neurodevelopmental disorders. Methods Data were collected retrospectively via file review from diagnostic clinics in Western Australia. Life adversity was coded using a standardised ACEs questionnaire. A total of 211 participants (72% males) with FASD with a mean age of 11 years (range = 2–21) were included in the final sample. 70% of the total sample had been involved with the child protection system and 40% had trouble with the law. Results Exposure to drinking/substance misuse at home (70%) and domestic violence (52%) were the two most common ACEs across the total sample. In the entire cohort, 39% had four or more ACEs, indicating higher risks of poor health outcomes. Additional stressors recorded were disengagement from school (43%), transiency (19%), victims of bullying (12%), traumatic brain injury (9%) and homelessness (5%). ACEs such as drinking/substance misuse at home, emotional neglect and physical neglect were positively associated with child protection system involvement. Additionally, exposure to domestic violence was positively correlated with justice system involvement. Higher rates of life adversity in this clinical population were associated with an increased number of comorbidities. Specifically, those with FASD who had comorbidities such as attachment disorder, substance use disorder, and PTSD also reported higher ACEs scores. Conclusion ACEs were common in this clinical population. Increased ACEs in this sample were associated with increased comorbidities and involvement with the child protection and/or justice system. This highlights that prevention, intervention and early diagnosis of FASD are important for at risk children to reduce the negative effects of ACEs. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03654-y.
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Affiliation(s)
- Grace Kuen Yee Tan
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia. .,Patches Australia, Subiaco, Australia. .,Telethon Kids Institute (TKI), Nedlands, Australia.
| | - Martyn Symons
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
| | - James Fitzpatrick
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Patches Australia, Subiaco, Australia
| | | | - Donna Cross
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
| | - Carmela F Pestell
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
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26
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Brown HK, Chen S, Guttmann A, Havercamp SM, Parish S, Ray JG, Vigod SN, Tarasoff LA, Lunsky Y. Neonatal Outcomes of Mothers With a Disability. Pediatrics 2022; 150:e2021055318. [PMID: 35934737 PMCID: PMC9694113 DOI: 10.1542/peds.2021-055318] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the risk of neonatal complications among women with a disability. METHODS This population-based cohort study comprised all hospital singleton livebirths in Ontario, Canada from 2003 to 2018. Newborns of women with a physical (N = 144 187), sensory (N = 44 988), intellectual or developmental (N = 2207), or ≥2 disabilities (N = 8823) were each compared with 1 593 354 newborns of women without a disability. Outcomes were preterm birth <37 and <34 weeks, small for gestational age birth weight (SGA), large for gestational age birth weight, neonatal morbidity, and mortality, neonatal abstinence syndrome (NAS), and NICU admission. Relative risks were adjusted for social, health, and health care characteristics. RESULTS Risks for neonatal complications were elevated among newborns of women with disabilities compared with those without disabilities. Adjusted relative risks were especially high for newborns of women with an intellectual or developmental disability, including preterm birth <37 weeks (1.37, 95% confidence interval 1.19-1.58), SGA (1.37, 1.24-1.59), neonatal morbidity (1.42, 1.27-1.60), NAS (1.53, 1.12-2.08), and NICU admission (1.53, 1.40-1.67). The same was seen for newborns of women with ≥2 disabilities, including preterm birth <37 weeks (1.48, 1.39-1.59), SGA (1.13, 1.07-1.20), neonatal morbidity (1.28, 1.20-1.36), NAS (1.87, 1.57-2.23), and NICU admission (1.35, 1.29-1.42). CONCLUSIONS There is a mild to moderate elevated risk for complications among newborns of women with disabilities. These women may need adapted and enhanced preconception and prenatal care, and their newborns may require extra support after birth.
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Affiliation(s)
- Hilary K. Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin HS Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Susan M. Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
| | - Susan Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Joel G. Ray
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Simone N. Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lesley A. Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Yona Lunsky
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
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Defrin R, Benromano T, Pick CG. Unique Pain Responses in Different Etiological Subgroups of Intellectual and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:417-430. [PMID: 36018766 DOI: 10.1352/1944-7558-127.5.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 01/25/2022] [Indexed: 06/15/2023]
Abstract
We studied whether there exist variations in pain responses between different intellectual and developmental disability (IDD) etiologies. Self-reports and facial expressions (Facial Action Coding System = FACS) were recorded during experimental pressure stimuli and compared among 31 individuals with IDD-13 with cerebral palsy (CP), nine with Down syndrome (DS), nine with unspecified origin (UIDD)-and among 15 typically developing controls (TDCs). The CP and DS groups had higher pain ratings and FACS scores compared to the UIDD and TDC groups, and steeper stimulus-response functions. The DS group exhibited the most diverse facial expressions. There were variations in the foci of facial expressions between groups. It appears that different IDD etiologies display distinct pain responses.
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Affiliation(s)
- Ruth Defrin
- Ruth Defrin, Tali Benromano, and Chaim G. Pick, Tel-Aviv University, Tel-Aviv, Israel
| | - Tali Benromano
- Ruth Defrin, Tali Benromano, and Chaim G. Pick, Tel-Aviv University, Tel-Aviv, Israel
| | - Chaim G Pick
- Ruth Defrin, Tali Benromano, and Chaim G. Pick, Tel-Aviv University, Tel-Aviv, Israel
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28
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Yin W, Döring N, Persson MSM, Persson M, Tedroff K, Ådén U, Sandin S. Gestational age and risk of intellectual disability: a population-based cohort study. Arch Dis Child 2022; 107:826-832. [PMID: 35470219 PMCID: PMC9411878 DOI: 10.1136/archdischild-2021-323308] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/26/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the association between gestational age at birth and risk of clinically diagnosed intellectual disability (ID) week by week to provide a detailed description of ID risk across the entire range of gestational ages and by severity of ID. METHODS All individuals born alive in Sweden 1974-2017 were prospectively followed up from birth until 2017 using national registers. The HRs for ID according to weekly gestational age and gestational age categories were determined using Cox models. Sibling analyses were conducted to adjust for familial confounding. RESULTS The study included 3 572 845 live births. During the follow-up, 26 596 ID cases were registered. The adjusted weekly estimates showed a gradual increase in risk of ID from week 40 to week 24 (adjusted HR37weeks=1.80 (1.74 to 1.87), aHR32weeks=3.93 (3.73 to 4.13), aHR28weeks=7.53 (6.95 to 8.16), aHR24weeks=21.58 (18.62 to 25.00)) and from week 41 onwards (aHR42weeks=1.26 (1.19 to 1.32)), with statistically significantly higher risks across the range of gestational age compared with infants born at week 40. The associations were consistent in mild, moderate and severe/profound ID but most prominent for severe/profound ID. CONCLUSION The risk of ID increased weekly as the date of delivery moved away from 40 weeks, both preterm and post-term. The results remained robust after detailed adjustment for confounding, including familial confounding.
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Affiliation(s)
- Weiyao Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .,Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Nora Döring
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Monica S M Persson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martina Persson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Ådén
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Psychiatry, Ichan School of Medicine at Mount Sinai, New York, New York, USA
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29
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Grineski SE, Renteria R, Collins TW, Mangadu A, Alexander C, Bilder D, Bakian A. Associations between estimates of perinatal industrial pollution exposures and intellectual disability in Utah children. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 836:155630. [PMID: 35508240 PMCID: PMC10077518 DOI: 10.1016/j.scitotenv.2022.155630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 06/14/2023]
Abstract
While heavy metals exposure is associated with intellectual disability (ID), little is known about associations between industrial pollution and ID. The objective of this analysis is to assess associations between estimated perinatal industrial pollution exposures from the US Environmental Protection Agency's Risk Screening Environmental Indicators Microdata and children's ID risk. We conducted a case-control study of children born in Utah from 2000 to 2008 (n = 1679). Cases were identified through the Center for Disease Control's Autism and Developmental Disabilities Monitoring Network's Utah site and matched with controls based on birth year, sex, and birth county. We used multivariable generalized estimating equations to examine associations between estimated perinatal industrial pollution exposures and ID risk. The fourth quartile of industrial pollution exposure was associated with increased odds of ID relative to the first (Odds Ratio [OR]: 1.73, 95% Confidence Interval [CI]: 1.23-2.44) and second (OR: 1.67, CI: 1.19-2.35) quartiles. Similarly, the third quartile was associated with increased odds of ID relative to the first (OR: 1.47, CI: 1.06-2.03) and second (OR: 1.41, CI: 1.02-1.96) quartiles. Findings were robust to varied model specifications. Maternal residential exposures to industrial pollution were associated with increased ID prevalence in Utah. Since environmental correlates of ID are understudied, additional research is needed.
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Affiliation(s)
- Sara E Grineski
- University of Utah, Department of Sociology, 380 S. 1530 E., Rm. 301, Salt Lake City, UT 84112, USA.
| | - Roger Renteria
- University of Utah, Department of Sociology, 380 S. 1530 E., Rm. 301, Salt Lake City, UT 84112, USA
| | - Timothy W Collins
- University of Utah, Department of Geography, 260 Central Campus Dr., Rm. 4728, Salt Lake City, UT 84112, USA
| | - Aparna Mangadu
- University of Texas at El Paso, BUILDing SCHOLARS Program, Chemistry & Computer Science Building, Room g0706, 500 W University, El Paso, TX 79968, USA
| | - Camden Alexander
- University of Utah, Department of Sociology, 380 S. 1530 E., Rm. 301, Salt Lake City, UT 84112, USA
| | - Deborah Bilder
- University of Utah School of Medicine, Department of Psychiatry, 30 N. 1900 E., Salt Lake City, UT 84132, USA
| | - Amanda Bakian
- University of Utah School of Medicine, Department of Psychiatry, 30 N. 1900 E., Salt Lake City, UT 84132, USA
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30
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Pham C, Bekkering S, O'Hely M, Burgner D, Thomson S, Vuillermin P, Collier F, Marx W, Mansell T, Symeonides C, Sly PD, Tang MLK, Saffery R, Ponsonby AL. Infant inflammation predicts childhood emotional and behavioral problems and partially mediates socioeconomic disadvantage. Brain Behav Immun 2022; 104:83-94. [PMID: 35618227 DOI: 10.1016/j.bbi.2022.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Emotional and behavioral problems (EBP) are common in children. Environmental factors like socioeconomic disadvantage influence EBP pathogenesis and can trigger inflammation. However, the link between early inflammation-EBP in children is unclear. We investigated the associations between i) infant inflammatory biomarkers and subsequent EBP and ii) early life environmental factors and EBP and assessed whether infant inflammation mediated these associations. METHODS Inflammatory biomarkers glycoprotein acetyls (GlycA) and high-sensitivity C-reactive protein (hsCRP) were quantified at birth and 12 months in a population-derived birth cohort, the Barwon Infant Study. Early life factors including demographic, prenatal, and perinatal factors were collected from antenatal to the two-year period. Internalizing and externalizing problems at age two were measured by the Child Behavior Checklist. Prospective associations were examined by multivariable regression analyses adjusted for potential confounders. Indirect effects of early life factors on EBP through inflammation were identified using mediation analyses. RESULTS Elevated GlycA levels at birth (GlycAbirth) were associated with greater internalizing problems at age two (β = 1.32 per SD increase in GlycA; P = 0.001). Inflammation at birth had a stronger magnitude of effect with later EBP than at 12 months. GlycAbirth partially mediated the associations between lower household income (6%), multiparity (12%) and greater number of older siblings (13%) and EBP. Patterns were less evident for hsCRP or externalizing problems. CONCLUSIONS GlycAbirth was positively associated with EBP at age two and partially mediated the association between several indicators of socioeconomic disadvantage and EBP. Prenatal and perinatal inflammation may be relevant to early neurodevelopment and emotional health.
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Affiliation(s)
- Cindy Pham
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3052, Australia
| | - Siroon Bekkering
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, GA 6625, the Netherlands
| | - Martin O'Hely
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Sarah Thomson
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia
| | - Peter Vuillermin
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; Barwon Health, Geelong, VIC 3220, Australia
| | - Fiona Collier
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; Barwon Health, Geelong, VIC 3220, Australia
| | - Wolfgang Marx
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Toby Mansell
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Christos Symeonides
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Peter D Sly
- Child Health Research Centre, University of Queensland, South Brisbane, QLD 4101, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3052, Australia.
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Vostrý M, Lanková B, Pešatová I, Fleischmann O, Jelínková J. Nonpharmacological Compensation of Aggressive Behavior of Individuals with Moderate Intellectual Disability and Behavioral Disorders-A Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159116. [PMID: 35897479 PMCID: PMC9368589 DOI: 10.3390/ijerph19159116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/17/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
The article discusses issues associated with the manifestations of aggressive behavior in an individual diagnosed with moderate intellectual disability and behavioral disorders (according to ICD-10; F7; F711—moderate intellectual disability, significant impairment of behavior requiring attention or treatment). In the research survey, we focused on a client corresponding with relevant features. The research was carried out at the beginning of hospitalization, ongoing hospitalization, and the end of hospitalization, followed by a recommendation to limit the legal capacity of the client and his placement in a residential care home. The case study points out individual approaches to special education and psychology and outlines the key steps in the cooperation of selected helping professions suggesting conclusions and recommendations for practice regarding these selected issues. Upon the termination of our investigation, there was a rapid deterioration of the client being admitted to the intensive care unit with a follow-up treatment in a long-term intensive care unit.
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Affiliation(s)
- Michal Vostrý
- Research Center, Faculty of Health Studies, University J. E. Purkyně in Ústí nad Labem, 40096 Ústí nad Labem, Czech Republic
- Department of Special and Social Education, Faculty of Education, University J. E. Purkyně, Ústí nad Labem in Ústí nad Labem, 40096 Ústí nad Labem, Czech Republic;
- Correspondence:
| | - Barbora Lanková
- Department of Primary and Pre-Primary Education, Faculty of Education, University J. E. Purkyně in Ústí nad Labem, 40001 Ústí nad Labem, Czech Republic;
| | - Ilona Pešatová
- Department of Special and Social Education, Faculty of Education, University J. E. Purkyně, Ústí nad Labem in Ústí nad Labem, 40096 Ústí nad Labem, Czech Republic;
| | - Otakar Fleischmann
- Department of Psychology, Faculty of Education, University J. E. Purkyně in Ústí nad Labem, 40096 Ústí nad Labem, Czech Republic;
| | - Jaroslava Jelínková
- Department of Languages, Faculty of Education, University J. E. Purkyně in Ústí nad Labem, 40096 Ústí nad Labem, Czech Republic;
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Madley-Dowd P, Kalkbrenner AE, Heuvelman H, Heron J, Zammit S, Rai D, Schendel D. Maternal smoking during pregnancy and offspring intellectual disability: sibling analysis in an intergenerational Danish cohort. Psychol Med 2022; 52:1847-1856. [PMID: 33050963 PMCID: PMC8044256 DOI: 10.1017/s0033291720003621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/19/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Maternal smoking has known adverse effects on fetal development. However, research on the association between maternal smoking during pregnancy and offspring intellectual disability (ID) is limited, and whether any associations are due to a causal effect or residual confounding is unknown. METHOD Cohort study of all Danish births between 1995 and 2012 (1 066 989 persons from 658 335 families after exclusions), with prospectively recorded data for cohort members, parents and siblings. We assessed the association between maternal smoking during pregnancy (18.6% exposed, collected during prenatal visits) and offspring ID (8051 cases, measured using ICD-10 diagnosis codes F70-F79) using logistic generalised estimating equation regression models. Models were adjusted for confounders including measures of socio-economic status and parental psychiatric diagnoses and were adjusted for family averaged exposure between full siblings. Adjustment for a family averaged exposure allows calculation of the within-family effect of smoking on child outcomes which is robust against confounders that are shared between siblings. RESULTS We found increased odds of ID among those exposed to maternal smoking in pregnancy after confounder adjustment (OR 1.35, 95% CI 1.28-1.42) which attenuated to a null effect following adjustment for family averaged exposure (OR 0.91, 95% CI 0.78-1.06). CONCLUSIONS Our findings are inconsistent with a causal effect of maternal smoking during pregnancy on offspring ID risk. By estimating a within-family effect, our results suggest that prior associations were the result of unmeasured genetic or environmental characteristics of families in which the mother smokes during pregnancy.
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Affiliation(s)
- Paul Madley-Dowd
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Amy E. Kalkbrenner
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Hein Heuvelman
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Stanley Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
- Avon and Wiltshire Partnership NHS Mental Health Trust, Bristol, UK
| | - Diana Schendel
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
- National Centre for Register-based Research, Department of Economics and Business, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Villamor E, Susser ES, Cnattingius S. Defective Placentation Syndromes and Intellectual Disability in the Offspring: Nationwide Cohort and Sibling-Controlled Studies. Am J Epidemiol 2022; 191:1557-1567. [PMID: 35380610 PMCID: PMC9618159 DOI: 10.1093/aje/kwac068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/11/2022] [Accepted: 04/01/2022] [Indexed: 01/29/2023] Open
Abstract
We investigated the relationships between syndromic manifestations of defective placentation and the incidence of intellectual disability (ID) in offspring by conducting a population-based cohort study of 1,581,200 nonmalformed, live singleton infants born in Sweden between 1998 and 2014. Exposures were: 1) placental abruption, 2) preterm preeclampsia (<34 weeks of gestation), 3) preeclampsia combined with infant being small for gestational age (SGA) at birth, and 4) spontaneous preterm birth. The outcome was an ID diagnosis after 3 years of age. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for each syndrome using Cox regression and robust variances. There were 9,451 children with ID (5.5 per 10,000 child-years). ID incidence rates increased with placental abruption (HR = 2.8, 95% CI: 2.3, 3.5), preterm preeclampsia (HR = 3.7, 95% CI: 2.9, 4.7), preeclampsia combined with SGA (HR = 3.3, 95% CI: 2.6, 4.1), and spontaneous preterm birth (for 32-36 and 22-31 weeks, respectively, HR = 1.6 (95% CI: 1.4, 1.8) and 5.2 (95% CI: 4.3, 6.2)). The same pattern of results was evident in sibling-controlled analyses among 1,043,158 full siblings. The strength of associations increased with ID severity. Preterm birth only partly explained the associations of placental abruption, preeclampsia, or SGA with ID. We conclude that defective placentation is related to increased incidence of ID in the offspring.
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Affiliation(s)
- Eduardo Villamor
- Correspondence to Dr. Eduardo Villamor, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 (e-mail: )
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Castaldelli-Maia JM, Bhugra D. Analysis of global prevalence of mental and substance use disorders within countries: focus on sociodemographic characteristics and income levels. Int Rev Psychiatry 2022; 34:6-15. [PMID: 35584016 DOI: 10.1080/09540261.2022.2040450] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This report presents the prevalence of mental and substance use disorders around the world discussing the impact of geographical, sociodemographic, and income characteristics on national epidemiological differences. We analysed data from the Institute of Health Metrics and Evaluation database published in 2019. The global prevalence of mental disorders was 13.0%, with higher prevalence of anxiety disorders rate (4.1%), followed by depressive disorders (3.8%, including major depressive disorder 2.49% and dysthymia 1.35%), intellectual disability (1.5%), ADHD (1.1%), conduct disorders (0.5%), bipolar disorders (0.5%), autism spectrum disorder s (0.4%), schizophrenia (0.3%), and eating disorders (0.2%, including bulimia nervosa 0.13% and anorexia nervosa 0.05%). The worldwide prevalence of substance-use disorders was 2.2%, not surprisingly, with higher prevalence of alcohol-use disorders (1.5%) than other drug-use disorders (0.8% total including: cannabis 0.32%; opioid 0.29%, amphetamine 0.10%; cocaine 0.06%). In general, high-income countries reported higher levels of mental and substance use disorders, with the exceptions of conduct and depressive disorders (no significant differences were found among low- and high-income countries), and intellectual disability (with higher prevalence in low-income countries). In regions of the America's prevalence rates of mental and substance use disorders were higher than in Europe. Western Pacific countries reported high levels of schizophrenia, and depressive disorders were highly prevalent in Africa as well as in the Americas. Intellectual disability reported higher rates in Eastern Mediterranean and South-East Asia. We discuss the cross-cultural variations in mental health expenditure and literacy as well as stigma-related factors and some of the environmental risk factors possibly related to these prevalence differences.
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Affiliation(s)
- João Mauricio Castaldelli-Maia
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil.,Department of Neuroscience, FMABC University Center, Santo André, Brazil.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Dinesh Bhugra
- Department of Mental Health & Cultural Diversity, IoPPN, Kings College, London, UK
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Association between craniofacial anomalies, intellectual disability and autism spectrum disorder: Western Australian population-based study. Pediatr Res 2022; 92:1795-1804. [PMID: 35352007 PMCID: PMC9771801 DOI: 10.1038/s41390-022-02024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/14/2022] [Accepted: 03/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Accurate knowledge of the relationship between craniofacial anomalies (CFA), intellectual disability (ID) and autism spectrum disorder (ASD) is essential to improve services and outcomes. The aim is to describe the association between CFA, ID and ASD using linked population data. METHODS All births (1983-2005; n = 566,225) including CFA births (comprising orofacial clefts, craniosynostosis, craniofacial microsomia and mandibulofacial dysostosis) surviving to 5 years were identified from the birth, death, birth defects and midwives population data sets. Linked data from these data sets were followed for a minimum of 5 years from birth until 2010 in the intellectual disability database to identify ID and ASD. These associations were examined using a modified Poisson regression. RESULTS Prevalence of ID and ASD was higher among CFA (especially with additional anomalies) than those without [prevalence ratio 5.27, 95% CI 4.44, 6.25]. It was higher among CFA than those with other gastrointestinal and urogenital anomalies but lower than nervous system and chromosomal anomalies. Children with CFA and severe ID had a higher proportion of nervous system anomalies. CONCLUSIONS Findings indicate increased ID and ASD among CFA but lower than nervous system and chromosomal anomalies. This population evidence can improve early identification of ID/ASD among CFA and support service planning. IMPACT Our study found about one in ten children born with craniofacial anomalies (CFA) are later identified with intellectual disability (ID). Prevalence of ID among CFA was higher than those with other gastrointestinal, urogenital, and musculoskeletal birth defects but lower than those with the nervous system and chromosomal abnormalities. Most children with craniofacial anomalies have a mild-to-moderate intellectual disability with an unknown aetiology. On average, intellectual disability is identified 2 years later for children born with non-syndromic craniofacial anomalies than those with syndromic conditions. Our findings can improve the early identification of ID/ASD among CFA and support service planning.
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Leonard H, Montgomery A, Wolff B, Strumpher E, Masi A, Woolfenden S, Williams K, Eapen V, Finlay-Jones A, Whitehouse A, Symons M, Licari M, Varcin K, Alvares G, Evans K, Downs J, Glasson E. A systematic review of the biological, social, and environmental determinants of intellectual disability in children and adolescents. Front Psychiatry 2022; 13:926681. [PMID: 36090348 PMCID: PMC9453821 DOI: 10.3389/fpsyt.2022.926681] [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: 04/22/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
AIM This systematic review aimed to identify the most important social, environmental, biological, and/or genetic risk factors for intellectual disability (ID). METHODS Eligible were published prospective or retrospective comparative studies investigating risk factors for ID in children 4-18 years. Exclusions were single group studies with no comparator without ID and a sample size <100. Electronic databases (Medline, Cochrane Library, EMBASE, PsycInfo, Campbell Collaboration, and CINAHL) were searched for eligible publications from 1980 to 2020. Joanna Briggs Institute critical appraisal instruments, appropriate for study type, were used to assess study quality and risk of bias. Descriptive characteristics and individual study results were presented followed by the synthesis for individual risk factors, also assessed using GRADE. RESULTS Fifty-eight individual eligible studies were grouped into six exposure topics: sociodemographic; antenatal and perinatal; maternal physical health; maternal mental health; environmental; genetic or biological studies. There were few eligible genetic studies. For half the topics, the certainty of evidence (GRADE) was moderate or high. CONCLUSION Multiple studies have examined individual potential determinants of ID, but few have investigated holistically to identify those populations most at risk. Our review would indicate that there are vulnerable groups where risk factors we identified, such as low socioeconomic status, minority ethnicity, teenage motherhood, maternal mental illness, and alcohol abuse, may cluster, highlighting a target for preventive strategies. At-risk populations need to be identified and monitored so that interventions can be implemented when appropriate, at preconception, during pregnancy, or after birth. This could reduce the likelihood of ID and provide optimal opportunities for vulnerable infants. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=120032], identifier [CRD42019120032].
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Affiliation(s)
- Helen Leonard
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Alicia Montgomery
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Brittany Wolff
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Elissa Strumpher
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Anne Masi
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Susan Woolfenden
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Valsamma Eapen
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Amy Finlay-Jones
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Martyn Symons
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Melissa Licari
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Kandice Varcin
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Gail Alvares
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Kiah Evans
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Emma Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
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Bowe AK, Staines A, Murray DM. Below Average Cognitive Ability-An under Researched Risk Factor for Emotional-Behavioural Difficulties in Childhood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412923. [PMID: 34948532 PMCID: PMC8702024 DOI: 10.3390/ijerph182412923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/22/2022]
Abstract
Children with below average cognitive ability represent a substantial yet under-researched population for whom cognitive and social demands, which increase in complexity year by year, may pose significant challenges. This observational study examines the longitudinal relationship between early cognitive ability and emotional-behavioral difficulties (EBDs) between the age of three and nine. Participants include 7134 children from the population-based cohort study growing up in Ireland. Cognitive ability was measured at age three using the Picture Similarities Scale. A t-score one to two standard deviations below the mean was defined as below average cognitive ability (n = 767). EBDs were measured using the Strengths and Difficulties Questionnaire (SDQ) at three, five, and nine years of age. Generalized linear mixed models and logistic regression were used to examine the relationship. Below average cognitive ability was an independent predictor of higher longitudinal SDQ scores. After adjustment, children with below average cognitive ability were 1.39 times more likely (AOR 1.39, 95% CI 1.17–1.66, p < 0.001) to experience a clinically significant EBD between the ages of three to nine years. This study demonstrates the increased risk of EBDs for children with below average cognitive ability. A scalable method of early identification of at-risk children should be a research priority for public health, enabling early intervention for cognitive and adaptive outcomes.
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Affiliation(s)
- Andrea K. Bowe
- INFANT Research Centre, Department of Paediatrics, University College Cork, T12 K8AF Cork, Ireland;
- Correspondence:
| | - Anthony Staines
- School of Nursing, Psychotherapy and Community Health, Dublin City University, 9 Dublin, Ireland;
| | - Deirdre M. Murray
- INFANT Research Centre, Department of Paediatrics, University College Cork, T12 K8AF Cork, Ireland;
- Department of Paediatrics and Child Health, Cork University Maternity Hospital, Wilton, T12 DC4A Cork, Ireland
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Lee PMY, Tse LA, László KD, Wei D, Yu Y, Li J. Association of maternal body mass index with intellectual disability risk. Arch Dis Child Fetal Neonatal Ed 2021; 106:584-590. [PMID: 33849956 DOI: 10.1136/archdischild-2020-320793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/25/2021] [Accepted: 03/13/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The study aimed to investigate the association between maternal body mass index (BMI) in early pregnancy and children's intellectual disability (ID) risk in the absence of chromosomal disorders, neurofibromatosis and tuberous sclerosis, taking adverse birth outcomes, maternal hypertension/diabetes and maternal socioeconomic status into consideration. METHODS We conducted a cohort study of singletons without common genetic defects born in Sweden during 1992-2006, and followed them from birth until 31 December 2014 (n=1 186 836). Cox proportional hazards models were used to analyse the association between maternal BMI in early pregnancy and the risk of offspring's ID. RESULTS The risk of ID was higher in children born to mothers who were underweight (HR=1.21, 95% CI=1.07 to 1.36), overweight (HR=1.28, 95% CI=1.21 to 1.34) or had obesity class I (HR=1.63, 95% CI=1.53 to 1.74), obesity class II (HR=2.08, 95% CI=1.88 to 2.30) and obesity class III (HR=2.31, 95% CI=1.46 to 3.65) than in children born to normal weight mothers. Results remained consistent after excluding children with adverse birth outcome or born to mothers with gestational hypertension/diabetes. Analysis stratified by maternal education and annual household income showed that the association between maternal underweight and children's ID risk was attenuated among children of mothers with tertiary education or with high income. CONCLUSIONS Our findings suggest that maternal underweight or overweight/obesity in early pregnancy was associated with the development of ID in their offspring. This association was independent of the effect of adverse birth outcomes and maternal hypertension/diabetes. High socioeconomic status may attenuate the risk of ID among children of underweight mothers. This study highlights the importance of improving health education before conception to reduce children's ID risk.
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Affiliation(s)
- Priscilla Ming Yi Lee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Lap Ah Tse
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Dang Wei
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - YongFu Yu
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus Universitet, Aarhus, Midtjylland, Denmark
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus Universitet, Aarhus, Midtjylland, Denmark
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Morinaga M, Hollander AC, Heuvelman H, Lundberg M, Dalman C, Rai D, Magnusson C. Migration and risk of intellectual disability with and without autism: A population-based cohort study. Acta Psychiatr Scand 2021; 144:487-500. [PMID: 34273179 DOI: 10.1111/acps.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/23/2021] [Accepted: 07/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether parental migration, parental region of origin, timing of child's birth in relation to maternal migration and parental reason for migration are associated with intellectual disability (ID) with and without autism. METHODS We used a register-based cohort of all individuals aged 0-17 years in Stockholm County during 2001-2011. General estimating equation logistic model and additionally sibling comparison were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). The models were adjusted for child's sex and birth year and parental age at child's birth, and additionally for migrant-specific variables in the analyses including only children with migrant parent(s). RESULTS Within the eligible sample of 670,098 individuals, 3781 (0.6%) had ID with autism, and 5076 (0.8%) had ID without autism. Compared with children with Swedish-born parents, children with both parents born abroad had an increased risk of ID with autism (OR = 1.6, CI 1.5-1.8) and ID without autism (OR = 1.9, CI 1.7-2.0). Among these children with both parents born abroad, it was protective of ID with autism when the child's birth occurred before and later than four years after maternal migration, which was replicated in the sibling comparison. The associations with both conditions were more pronounced with parental origin in regions comprising low- and middle-income countries and with reasons other than work or study. CONCLUSIONS Parental migration is associated with ID regardless of co-occurrence of autism. Our results indicate an association between environmental factors during pregnancy related to migration and offspring ID with autism, although further confirmative studies are needed.
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Affiliation(s)
- Maki Morinaga
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Hein Heuvelman
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Michael Lundberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Dheeraj Rai
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,NIHR Biomedical Research Centre, University of Bristol, Bristol, UK.,Avon and Wiltshire Partnership National Health Service Mental Health Trust, Bath, UK
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Tseng YC, Lai DC, Guo HR. Language and Culture Backgrounds of Mothers and Child Development: A Nationwide Study on the Incidence of Developmental Delays in Children Born to Immigrant Mothers in Taiwan. Front Public Health 2021; 9:646444. [PMID: 34504823 PMCID: PMC8421523 DOI: 10.3389/fpubh.2021.646444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Transnational marriages are common as a result of globalization, and immigrant mothers face various degrees of differences in language and culture backgrounds. Mothers have great influences on the development of their children, but the effects of immigrant mothers' language and culture backgrounds on developmental delays (DD) are seldom studied. To evaluate the potential effects of immigrant mothers' language and culture backgrounds on DD of their children, we conducted a nationwide study in Taiwan. Methods: We analyzed the data from the national registry of DD in Taiwan from 2010 to 2013 and compared the incidence of DD in young children born to mothers from China, Vietnam, and Indonesia, where most of the immigrant mothers in Taiwan come from. Amongst the three countries, China is the closest to Taiwan in terms of language and culture, followed by Vietnam, and then Indonesia. Results: We identified 4,604 patients of DD in children under 7 years old. The incidence rates showed an increasing trend among children born to mothers from China, Vietnam, and Indonesia (p < 0.01 in all years). Using children born to mothers from Vietnam, whose incidence rate of DD was in the middle amongst the three groups, as the reference, we found the incidence rate ratios in children born to mothers from China ranged from 0.65 to 0.73, and those in children born to mothers from Indonesia ranged from 1.04 to 1.26. Conclusions: The findings support the important role of mothers' language and culture backgrounds in the development of children.
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Affiliation(s)
- Yen-Cheng Tseng
- Language Education Center and Department of Tourism, Food, and Beverage Management, Chang Jung Christian University, Tainan, Taiwan
| | - Der-Chung Lai
- Department of Physical Medicine and Rehabilitation, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Nursing, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - How-Ran Guo
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Occupational Safety, Health and Medicine Research Center, National Cheng Kung University, Tainan, Taiwan.,Department of Environmental and Occupational Health, National Cheng Kung University Hospital, Tainan, Taiwan
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Havdahl A, Farmer C, Schjølberg S, Øyen AS, Surén P, Reichborn-Kjennerud T, Magnus P, Bresnahan M, Hornig M, Susser E, Lipkin WI, Lord C, Stoltenberg C, Thurm A, Bishop S. Age of walking and intellectual ability in autism spectrum disorder and other neurodevelopmental disorders: a population-based study. J Child Psychol Psychiatry 2021; 62:1070-1078. [PMID: 33369747 PMCID: PMC8236490 DOI: 10.1111/jcpp.13369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Delayed walking is common in intellectual disability (ID) but may be less common when ID occurs with autism spectrum disorder (ASD). Previous studies examining this were limited by reliance on clinical samples and exclusion of children with severe motor deficits. OBJECTIVE To examine in a population-based sample if age of walking is differentially related to intellectual ability in children with ASD versus other neurodevelopmental disorders (NDD). METHODS Participants were from the nested Autism Birth Cohort Study of the Norwegian Mother, Father and Child Cohort Study (MoBa). Cox proportional hazards regression assessed if diagnosis (ASD n = 212 vs. NDD n = 354), continuous nonverbal IQ, and their interaction, were associated with continuous age of walking. RESULTS The relationship between nonverbal IQ and age of walking was stronger for NDD than for ASD (Group × nonverbal IQ interaction, χ2 = 13.93, p = .0002). This interaction was characterized by a 21% decrease in the likelihood of walking onset at any given time during the observation period per 10-point decrease in nonverbal IQ (hazard ratio = 0.79, 95% CI: 0.78-0.85) in the NDD group compared to 8% (hazard ratio = 0.92, 95% CI: 0.86-0.98) in the ASD group. CONCLUSIONS The finding that age of walking is less strongly related to low intellectual ability in children with ASD than in children without other NDDs supports the hypothesis that ID in ASD may result from heterogeneous developmental pathways. Late walking may be a useful stratification variable in etiological research focused on ASD and other NDDs.
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Affiliation(s)
- Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway.,MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Cristan Farmer
- Pediatrics & Developmental Neuroscience Branch, National Institute of Mental Health, Bethesda, MD, USA
| | | | - Anne-Siri Øyen
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Surén
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway
| | - Michaeline Bresnahan
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Mady Hornig
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Ezra Susser
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - W Ian Lipkin
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.,Center for Infection and Immunity, Mailman School of Public Health and Departments of Neurology and Pathology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Catherine Lord
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Audrey Thurm
- Pediatrics & Developmental Neuroscience Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Somer Bishop
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
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Lee P, Tse LA, László KD, Wei D, Yu Y, Li J. Association of maternal gestational weight gain with intellectual developmental disorder in the offspring: a nationwide follow-up study in Sweden. BJOG 2021; 129:540-549. [PMID: 34455681 DOI: 10.1111/1471-0528.16887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the association between maternal gestational weight gain (GWG) and offspring's intellectual developmental disorders (IDD); how this association is modified by maternal early-pregnancy BMI. DESIGN Population-based cohort study. SETTING AND POPULATION All liveborn singletons with information on maternal GWG in the Swedish Medical Register during 1992-2006 (n = 467 485). METHODS We used three GWG classifications, (1) Institute of Medicine (IOM) guidelines ('ideal' GWG: maternal underweight = 12.7-18.1 kg; normal = 11.3-15.9 kg; overweight = 6.8-11.3 kg; obesity = 5.0-9.1 kg), (2) LifeCycle project recommendation ('ideal' GWG: maternal underweight = 14.0-16.0 kg; normal = 10.0-18.0 kg; overweight = 2.0-16.0 kg; obesity class I = 2.0-6.0 kg; obesity class II ≤0.0-4.0 kg; obesity class III ≤0.0-6.0 kg) and (3) GWG centiles. Hazard ratio (HR) and 95% CI for offspring's IDD risk using Cox regression. MAIN OUTCOME MEASURES IDD was extracted from Swedish National Patient Register (code ICD-9:317-319/ICD-10:F70-F79). RESULTS Forty-one per cent of children were born to mothers with excessive GWG, 32.8% with ideal GWG and 26.2% with inadequate GWG according to IOM guidelines. Inadequate GWG was associated with 21% higher risk of offspring's IDD (95% CI 1.11-1.31) relative to ideal GWG. In contrast, when using the LifeCycle classification, children of mothers with inadequate GWG (HR 1.14, 95% CI 1.05-1.24) or excessive GWG (HR 1.09, 95% CI 1.01-1.17) had higher risks of IDD than those of mothers with ideal GWG. When using GWG centiles, extremely low GWG (<20th centile) and low GWG (20th-40th centile) were associated with elevated offspring's IDD risk. Further stratified analysis by maternal early-pregnancy body mass index (BMI) showed that overweight/obese mothers (BMI ≥25 kg/m2 ) with extremely excessive GWG (>25 kg) was associated with an increased offspring's IDD. CONCLUSION Our findings suggest that inadequate maternal GWG may increase offspring's IDD risk, irrespective of maternal early-pregnancy BMI. Extremely excessive GWG (>25 kg) may increase offspring's IDD risk, but only among mothers with an early-pregnancy BMI ≥25 kg/m2 . TWEETABLE ABSTRACT Inadequate maternal weight gain during pregnancy may increase the risk of offspring's intellectual disability, regardless of maternal BMI.
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Affiliation(s)
- Pmy Lee
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - L A Tse
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - K D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - D Wei
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Y Yu
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - J Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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Dupont-Soares M, Dos Santos M, Garcia EM, Soares MCF, Muccillo-Baisch AL, da Silva Júnior FMR. Maternal, neonatal and socio-economic factors associated with intellectual development among children from a coal mining region in Brazil. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:3055-3066. [PMID: 33496915 DOI: 10.1007/s10653-021-00817-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
Coal is the most aggressive energy sources in the environment. Several adverse outcomes on children's health exposure to coal pollutants have been reported. Pollutants from coal power plants adversely affect the intellectual development and capacity. The present study aimed to evaluate the intellectual development and associated factors among children living a city under the direct influence (DI) and six neighboring municipalities under the indirect influence (II) of coal mining activity in the largest coal reserve of Brazil. A structured questionnaire was completed by the child's guardian, and Raven's Progressive Color Matrices were administered to each child to assess intellectual development. A total of 778 children participated. In general, no significant difference was observed between the two cities. The DI city had better socioeconomic conditions than the II municipalities according to family income (< 0.001). The prevalence of children who were intellectually below average or with intellectual disabilities was 22.9%, and there was no significant difference (p > 0.05) between municipalities. In both unadjusted and adjusted analyses, intellectual development was associated with maternal age, marital situation and maternal education level, birth weight, breast feeding, frequent children's daycare, paternal participation in children's care and child growth. Living in the DI area was not associated with intellectual disability. The results suggest that socioeconomic conditions and maternal and neonatal outcomes are more important than environmental factors for intellectual development of children living in a coal mining area.
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Affiliation(s)
- Marcela Dupont-Soares
- Programa de Pós Graduação eôôm Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá 102 Centro, Rio Grande-RS, 96203-900, Brazil
| | - Marina Dos Santos
- Programa de Pós Graduação eôôm Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá 102 Centro, Rio Grande-RS, 96203-900, Brazil
- Laboratório de Ensaios Farmacológicos E Toxicológicos - LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande - FURG, Av. Itália, km 8, Campus Carreiros, Rio Grande - RS, CEP 96203-900, Brazil
| | - Edariane Menestrino Garcia
- Programa de Pós Graduação eôôm Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá 102 Centro, Rio Grande-RS, 96203-900, Brazil
| | - Maria Cristina Flores Soares
- Programa de Pós Graduação eôôm Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá 102 Centro, Rio Grande-RS, 96203-900, Brazil
- Laboratório de Ensaios Farmacológicos E Toxicológicos - LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande - FURG, Av. Itália, km 8, Campus Carreiros, Rio Grande - RS, CEP 96203-900, Brazil
| | - Ana Luiza Muccillo-Baisch
- Programa de Pós Graduação eôôm Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá 102 Centro, Rio Grande-RS, 96203-900, Brazil
- Laboratório de Ensaios Farmacológicos E Toxicológicos - LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande - FURG, Av. Itália, km 8, Campus Carreiros, Rio Grande - RS, CEP 96203-900, Brazil
| | - Flavio Manoel Rodrigues da Silva Júnior
- Programa de Pós Graduação eôôm Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá 102 Centro, Rio Grande-RS, 96203-900, Brazil.
- Laboratório de Ensaios Farmacológicos E Toxicológicos - LEFT, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande - FURG, Av. Itália, km 8, Campus Carreiros, Rio Grande - RS, CEP 96203-900, Brazil.
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Morinaga M, Rai D, Hollander AC, Petros N, Dalman C, Magnusson C. Migration or ethnic minority status and risk of autism spectrum disorders and intellectual disability: systematic review. Eur J Public Health 2021; 31:304-312. [PMID: 33049777 PMCID: PMC8071599 DOI: 10.1093/eurpub/ckaa108] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is an emerging evidence that the migration and the ethnic minority status are associated with the risks of autism spectrum disorder (ASD) and intellectual disability (ID). This systematic review aimed to investigate whether associations are specific to ASD or ID; whether and which migration-related or ethnically determined factors are associated with the risk of ASD and ID; and what mechanisms may explain these risks. METHODS A systematic literature search was conducted using Embase, Medline and PsycINFO for studies reporting on the risks of ASD and/or ID among migrants, descendants of migrants and/or ethnic minorities. Risks of any ASD, ASD + ID, ASD - ID and any ID were reviewed in relation to migration and ethnic minority status, with consideration to the study quality. In addition, possible underlying mechanisms suggested in the included studies were summarized. RESULTS Thirty-five studies were included. The summarized evidence indicated an increased risk of ASD + ID and a decreased risk of ASD - ID in migrants, descendants of migrants and ethnic minorities. These associations appeared more pronounced among children of migrant mothers, with origin in low-income countries, and among descendants of migrants. Data on ID were scarce. Suggested mechanisms explaining the increased risks of ASD + ID included environmental factors acting in utero and genetic factors (including consanguinity), while ascertainment bias was proposed to account for the lowered risks of diagnosed ASD - ID. CONCLUSION Migration-related factors acting in utero and/or associated with origin in low-income countries may be important in the ASD + ID aetiology, although further confirmative studies are needed.
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Affiliation(s)
- Maki Morinaga
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Dheeraj Rai
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,National Institute for Health Research Biomedical Research Centre, University of Bristol, Bristol, UK.,Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Avon and Wiltshire Partnership National Health Service Mental Health Trust, Bristol, UK
| | | | - Nuhamin Petros
- National Swedish Prevention of Mental Ill-Health and Suicide (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Ji H, Yu Y, Miao M, Qian X, Yuan W, Lin Y, Liang H, Li J. Risk of intellectual disability and maternal history of spontaneous abortion: a nationwide cohort study. Dev Med Child Neurol 2021; 63:831-838. [PMID: 33580539 DOI: 10.1111/dmcn.14839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Abstract
AIM To investigate the association between a maternal history of spontaneous abortion and intellectual disability in children. METHOD This cohort study included 1 778 786 children (913 340 males, 865 085 females, 361 missing data; mean age 15y 2mo, SD 8y 11mo, range birth to 40y) born in Denmark between 1977 and 2016. Cox proportional hazard regression was used to estimate the hazard ratios (HRs) of intellectual disability. RESULTS The overall HR of intellectual disability for children with a maternal history of spontaneous abortion was 1.17 (95% confidence interval [CI] 1.12-1.22) and the risk for multiple spontaneous abortions (HR=1.30, 95% CI 1.20-1.40) was higher than for a single spontaneous abortion (HR=1.13, 95% CI 1.07-1.18). When only cases of inpatient intellectual disability were included, the estimates increased slightly: the overall HR was 1.22 (95% CI 1.12-1.32), the HR for multiple spontaneous abortions was 1.37 (95% CI 1.20-1.58), and the HR for a single spontaneous abortion was 1.17 (95% CI 1.07-1.28). The risks were similar regardless of whether spontaneous abortion occurred before or after the index delivery. Estimates were nearly unchanged after adjusting for preterm birth, low birthweight, or Apgar score. INTERPRETATION Children born to mothers with spontaneous abortion, especially multiple spontaneous abortions, may be at a higher risk of intellectual disability in later life, regardless of whether spontaneous abortion occurred before or after the index delivery. The findings have clinical implications for targeted early intervention of children with intellectual disability. What this paper adds A maternal history of spontaneous abortion was associated with a risk of intellectual disability in offspring. The risk was higher in children whose mothers previously had multiple spontaneous abortions. Similar risks were observed regardless of whether spontaneous abortion occurred before or after childbirth.
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Affiliation(s)
- Honglei Ji
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, Shanghai, China.,Department of Maternal, Child and Adolescent Health, School of Public Health and Global Health Institute, Fudan University, Shanghai, China
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health and Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Maohua Miao
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, Shanghai, China.,Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Xu Qian
- Department of Maternal, Child and Adolescent Health, School of Public Health and Global Health Institute, Fudan University, Shanghai, China
| | - Wei Yuan
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, Shanghai, China
| | - Yi Lin
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Liang
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, Shanghai, China.,Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jiong Li
- Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Giachero A, Quadrini A, Pisano F, Calati M, Rugiero C, Ferrero L, Pia L, Marangolo P. Procedural Learning through Action Observation: Preliminary Evidence from Virtual Gardening Activity in Intellectual Disability. Brain Sci 2021; 11:766. [PMID: 34207553 PMCID: PMC8226894 DOI: 10.3390/brainsci11060766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 12/23/2022] Open
Abstract
Intellectual disability (ID) compromises intellectual and adaptive functioning. People with an ID show difficulty with procedural skills, with loss of autonomy in daily life. From an embodiment perspective, observation of action promotes motor skill learning. Among promising technologies, virtual reality (VR) offers the possibility of engaging the sensorimotor system, thus, improving cognitive functions and adaptive capacities. Indeed, VR can be used as sensorimotor feedback, which enhances procedural learning. In the present study, fourteen subjects with an ID underwent progressive steps training combined with VR aimed at learning gardening procedures. All participants were trained twice a week for fourteen weeks (total 28 sessions). Participants were first recorded while sowing zucchini, then they were asked to observe a virtual video which showed the correct procedure. Next, they were presented with their previous recordings, and they were asked to pay attention and to comment on the errors made. At the end of the treatment, the results showed that all participants were able to correctly garden in a real environment. Interestingly, action observation facilitated, not only procedural skills, but also specific cognitive abilities. This evidence emphasizes, for the first time, that action observation combined with VR improves procedural learning in ID.
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Affiliation(s)
- Alberto Giachero
- Aphasia Experimental Laboratory-Fondazione Carlo Molo Onlus, 10121 Turin, Italy; (A.G.); (M.C.); (C.R.)
- Dipartimento di Psicologia, University of Turin, 10124 Turin, Italy;
| | | | - Francesca Pisano
- Dipartimento di Studi Umanistici, University Federico II, 80133 Naples, Italy;
| | - Melanie Calati
- Aphasia Experimental Laboratory-Fondazione Carlo Molo Onlus, 10121 Turin, Italy; (A.G.); (M.C.); (C.R.)
| | - Cristian Rugiero
- Aphasia Experimental Laboratory-Fondazione Carlo Molo Onlus, 10121 Turin, Italy; (A.G.); (M.C.); (C.R.)
| | - Laura Ferrero
- Fondazione Agape dello Spirito Santo Onlus-Villa Lauro, 10132 Turin, Italy;
| | - Lorenzo Pia
- Dipartimento di Psicologia, University of Turin, 10124 Turin, Italy;
| | - Paola Marangolo
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy;
- Dipartimento di Studi Umanistici, University Federico II, 80133 Naples, Italy;
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Blue NR, Hoffman M, Allshouse AA, Grobman WA, Simhan HN, Turan OM, Parry S, Chung JH, Reddy U, Haas DM, Myers S, Mercer B, Saade GR, Silver RM. Antenatal Fetal Adrenal Measurements at 22 to 30 Weeks' Gestation, Fetal Growth Restriction, and Perinatal Morbidity. Am J Perinatol 2021; 38:676-682. [PMID: 31756754 PMCID: PMC7708295 DOI: 10.1055/s-0039-3400308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Our objective was to test the association of fetal adrenal size with perinatal morbidity among fetuses with fetal growth restriction (FGR; estimated fetal weight [EFW] < 10th percentile). STUDY DESIGN This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) adrenal study, which measured fetal adrenal gland size at 22 to 30 weeks' gestation. We analyzed the transverse adrenal area (TAA) and fetal zone area (absolute measurements and corrected for fetal size) and the ratio of the fetal zone area to the total transverse area using a composite perinatal outcome of stillbirth, neonatal intensive care unit admission, respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity, sepsis, mechanical ventilation, seizure, or death. Among fetuses with FGR, adrenal measurements were compared between those that did and did not experience the composite perinatal outcome. RESULTS There were 1,709 eligible neonates. Seven percent (n = 120) were diagnosed with FGR at the time of adrenal measurement, and 14.7% (n = 251) experienced perinatal morbidity. EFW-corrected and absolute adrenal measurements were similar among fetuses with and without FGR as well as among those who did and did not experience morbidity. The area under the curve for corrected TAA was 0.52 (95% confidence interval 0.38-0.67). CONCLUSION In our cohort, adrenal size was not associated with risk of morbidity among fetuses with FGR.
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Affiliation(s)
- Nathan R Blue
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Matthew Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware
| | - Amanda A Allshouse
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Ozhan M Turan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California
| | - Uma Reddy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen Myers
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas
| | - Brian Mercer
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
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48
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Madley-Dowd P, Lundberg M, Heron J, Zammit S, Ahlqvist VH, Magnusson C, Rai D. Maternal smoking and smokeless tobacco use during pregnancy and offspring development: sibling analysis in an intergenerational Swedish cohort. Int J Epidemiol 2021; 50:1840-1851. [PMID: 34999852 PMCID: PMC8743113 DOI: 10.1093/ije/dyab095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background The association between maternal smoking in pregnancy and offspring intellectual disability (ID) is less well understood than that of smoking and fetal growth restriction. As fetal growth and cognitive development may share similar confounding structures, comparison of the two associations may improve understanding of the causal nature of the association with ID. Furthermore, comparisons of smoking with smokeless tobacco use may aid identification of mechanisms of action. Methods This was a cohort study of all Swedish births between 1999 and 2012 (n = 1 070 013), with prospectively recorded data. We assessed the association between maternal smoking during pregnancy and offspring outcomes ID and born small for gestational age (SGA). Analyses were repeated for snus use in pregnancy. Using a sibling design, we estimated within-family effects that control for shared sibling characteristics. Results Those exposed to maternal smoking in pregnancy had increased odds of ID [odds ratio (OR) = 1.24, 95% confidence interval (CI): 1.16-1.33] and SGA (OR = 2.19, 95% CI: 2.11-2.27) after confounder adjustment. Within-family effects were found for SGA (OR = 1.44, 95% CI: 1.27-1.63) but not ID (OR = 0.92, 95% CI: 0.74-1.14). For snus use, the results for ID were similar to smoking. We found increased odds of offspring SGA among mothers who used snus in pregnancy in sensitivity analyses but not in primary analyses. Conclusions Our findings are consistent with a causal effect of maternal smoking in pregnancy on risk of offspring born SGA but not on risk of ID. We found no evidence for a causal effect of snus use in pregnancy on ID and inconclusive evidence for SGA.
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Affiliation(s)
- Paul Madley-Dowd
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Lundberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stanley Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Avon and Wiltshire Partnership, NHS Mental Health Trust, Bristol, UK
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49
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Avşar TS, McLeod H, Jackson L. Health outcomes of smoking during pregnancy and the postpartum period: an umbrella review. BMC Pregnancy Childbirth 2021; 21:254. [PMID: 33771100 PMCID: PMC7995767 DOI: 10.1186/s12884-021-03729-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Smoking during pregnancy (SDP) and the postpartum period has serious health outcomes for the mother and infant. Although some systematic reviews have shown the impact of maternal SDP on particular conditions, a systematic review examining the overall health outcomes has not been published. Hence, this paper aimed to conduct an umbrella review on this issue. METHODS A systematic review of systematic reviews (umbrella review) was conducted according to a protocol submitted to PROSPERO ( CRD42018086350 ). CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, CRD Database and HMIC databases were searched to include all studies published in English by 31 December 2017, except those focusing exclusively on low-income countries. Two researchers conducted the study selection and quality assessment independently. RESULTS The review included 64 studies analysing the relationship between maternal SDP and 46 health conditions. The highest increase in risks was found for sudden infant death syndrome, asthma, stillbirth, low birth weight and obesity amongst infants. The impact of SDP was associated with the number of cigarettes consumed. According to the causal link analysis, five mother-related and ten infant-related conditions had a causal link with SDP. In addition, some studies reported protective impacts of SDP on pre-eclampsia, hyperemesis gravidarum and skin defects on infants. The review identified important gaps in the literature regarding the dose-response association, exposure window, postnatal smoking. CONCLUSIONS The review shows that maternal SDP is not only associated with short-term health conditions (e.g. preterm birth, oral clefts) but also some which can have life-long detrimental impacts (e.g. obesity, intellectual impairment). IMPLICATIONS This umbrella review provides a comprehensive analysis of the overall health impacts of SDP. The study findings indicate that while estimating health and cost outcomes of SDP, long-term health impacts should be considered as well as short-term effects since studies not including the long-term outcomes would underestimate the magnitude of the issue. Also, interventions for pregnant women who smoke should consider the impact of reducing smoking due to health benefits on mothers and infants, and not solely cessation.
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Affiliation(s)
- Tuba Saygın Avşar
- Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Hugh McLeod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 2NT, UK
- National Institute for Health Research Applied Research Collaboration (NIHR ARC) West at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Louise Jackson
- Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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50
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Fenton TR, Nasser R, Creighton D, Tang S, Sauve R, Bilan D, Fenton CJ, Eliasziw M. Weight, length, and head circumference at 36 weeks are not predictive of later cognitive impairment in very preterm infants. J Perinatol 2021; 41:606-614. [PMID: 33037316 DOI: 10.1038/s41372-020-00855-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess diagnostic accuracy of 36-week anthropometric weight, length, and head circumference <10th and <3rd percentiles to predict preterm infant cognitive impairment. STUDY DESIGN Cohort study of 898 preterm <30-week very-low-birth weight (<1500 g) infants. Anthropometric measures' accuracy to predict cognitive impairment (Bayley-III Cognitive Composite score) <80, 21-months corrected age (CA) and Wechsler Preschool and Primary Scale of Intelligence Quotient (intellectual outcomes) <70, 36-months CA, were determined using receiver operating characteristic (ROC) curves. RESULT Thirty-six-week weight, length or head circumference <10th or <3rd percentile did not predict cognitive impairment; areas under ROC curves were <0.6. Sensitivities and specificities for 10th and 3rd percentile cut points were all poor, with most not exceeding 70%, whether the Fenton 2013 or INTERGROWTH 2015 growth charts were used. Brain injury and low maternal education were better predictors of cognitive impairment. CONCLUSION Preterm infant 36-week anthropometric measurements are not accurate predictors of cognitive impairment.
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Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Nutrition Services, Alberta Health Services, Calgary, AB, Canada.
| | - Roseann Nasser
- Saskatchewan Heath Authority, Nutrition and Food Services, Pasqua Hospital, Regina, SK, Canada
| | - Dianne Creighton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Selphee Tang
- Neonatal Follow-up Clinic, Alberta Health Services, Calgary, AB, Canada
| | - Reg Sauve
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Denise Bilan
- Saskatchewan Heath Authority, Nutrition and Food Services, Pasqua Hospital, Regina, SK, Canada
| | - Carol J Fenton
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Misha Eliasziw
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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