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Laaksonen S, Saraste M, Sucksdorff M, Nylund M, Vuorimaa A, Matilainen M, Heikkinen J, Airas L. Early prognosticators of later TSPO-PET-measurable microglial activation in multiple sclerosis. Mult Scler Relat Disord 2023; 75:104755. [PMID: 37216883 DOI: 10.1016/j.msard.2023.104755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Factors driving increased innate immune cell activation in multiple sclerosis (MS) brain are not well understood. As higher prevalence of microglial/macrophage activation in association with chronic lesions and diffusely in the normal appearing white matter predict more rapid accumulation of clinical disability, it is of high importance to understand processes behind this. Objective of the study was to explore demographic, clinical and paraclinical variables associating with later positron emission tomography (PET)-measurable innate immune cell activation. METHODS PET-imaging using a TSPO-binding [11C]PK11195 was performed to evaluate microglial activation in patients with relapsing-remitting MS aged 40-55 years with a minimum disease duration of five years (n = 37). Medical records and diagnostic MR images were reviewed for relevant early MS disease-related clinical and paraclinical parameters. RESULTS More prominent microglial activation was associated with higher number of T2 lesions in the diagnostic MRI, a higher immunoglobulin G (IgG) index in the diagnostic CSF and Expanded Disability Status Scale (EDSS) ≥ 2.0 five years after diagnosis. CONCLUSION The number of T2 lesions in MRI, and CSF immunoglobulin content measured by IgG index at the time of MS diagnosis associated with later TSPO-PET-measurable innate immune cell activation. This suggests that both focal and diffuse early inflammatory phenomena impact the development of later progression-related pathology.
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Affiliation(s)
- S Laaksonen
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland; Division of Clinical Neurosciences, University of Turku, Turku, Finland; Neurocenter Turku, University Hospital, Turku, Finland.
| | - M Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland; Division of Clinical Neurosciences, University of Turku, Turku, Finland; Neurocenter Turku, University Hospital, Turku, Finland
| | - M Sucksdorff
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland; Division of Clinical Neurosciences, University of Turku, Turku, Finland; Neurocenter Turku, University Hospital, Turku, Finland
| | - M Nylund
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland; Division of Clinical Neurosciences, University of Turku, Turku, Finland; Neurocenter Turku, University Hospital, Turku, Finland
| | - A Vuorimaa
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland; Division of Clinical Neurosciences, University of Turku, Turku, Finland; Neurocenter Turku, University Hospital, Turku, Finland
| | - M Matilainen
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland; Faculty of Science and Engineering, Åbo Akademi University, Turku, Finland
| | - J Heikkinen
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - L Airas
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland; Division of Clinical Neurosciences, University of Turku, Turku, Finland; Neurocenter Turku, University Hospital, Turku, Finland
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Ståhlberg T, Upadhyaya S, Khanal P, Sucksdorff M, Luntamo T, Suominen A, Sourander A. Preterm birth, poor foetal growth and anxiety disorders in a Finnish nationwide register sample. Acta Paediatr 2022; 111:1556-1565. [PMID: 35488484 PMCID: PMC9545468 DOI: 10.1111/apa.16377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
Abstract
Aim We examined the associations between preterm birth, poor foetal growth and anxiety disorders among children and adolescents. Additionally, we examined the impact of common comorbidities and specific anxiety disorders separately. Methods Three Finnish registers provided data on a nationwide birth cohort of 22,181 cases with anxiety disorders and 74,726 controls. Conditional logistic regression was used to examine the associations. Results Extremely very preterm birth and moderate‐late preterm birth were associated with increased adjusted odds ratios (aOR) for anxiety disorders (aOR 1.39, 95% CI 1.11–1.75 and aOR 1.13, 95% CI 1.03–1.23, respectively). Weight for gestational age of less than −2SD (aOR 1.29, 95% CI 1.17–1.42) and −2SD to −1SD (aOR 1.08, 95% CI 1.03–1.14) were associated with increased odds ratios for anxiety disorders. When comorbidities were considered, the associations became statistically insignificant for pure anxiety disorders, but remained significant in the groups with comorbid depressive or neurodevelopmental disorders. Conclusion Preterm birth and poor foetal growth increased the odds for anxiety disorders. However, the associations seem to be explained by the conditions of comorbid depressive and neurodevelopmental disorders. Comorbidities should be considered when examining and treating child and adolescent anxiety disorders.
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Affiliation(s)
- Tiia Ståhlberg
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
| | - Subina Upadhyaya
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
| | - Prakash Khanal
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
| | - Minna Sucksdorff
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
- Department of Pediatrics Turku University Hospital Turku Finland
| | - Terhi Luntamo
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
- Department of Child Psychiatry Turku University Hospital Turku Finland
| | - Auli Suominen
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
| | - Andre Sourander
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
- Department of Child Psychiatry Turku University Hospital Turku Finland
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Sourander A, Upadhyaya S, Surcel HM, Hinkka-Yli-Salomäki S, Cheslack-Postava K, Silwal S, Sucksdorff M, McKeague IW, Brown AS. Maternal Vitamin D Levels During Pregnancy and Offspring Autism Spectrum Disorder. Biol Psychiatry 2021; 90:790-797. [PMID: 34602240 PMCID: PMC8752030 DOI: 10.1016/j.biopsych.2021.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Findings from previous studies on maternal 25-hydroxyvitamin D [25(OH)D] levels during pregnancy and autism spectrum disorder (ASD) in offspring are inconsistent. METHODS The association between maternal 25(OH)D levels during pregnancy and offspring ASD was examined using data from a nationwide population-based register with a nested case-control study design. The ASD cases (n = 1558) were born between 1987 and 2004 and received a diagnosis of ASD by 2015; cases were matched with an equal number of controls. Maternal 25(OH)D levels during pregnancy were measured using quantitative immunoassay from maternal sera collected during the first and early second trimesters and archived in the national biobank of the Finnish Maternity Cohort. Conditional logistic regression examined the association between maternal 25(OH)D levels and offspring ASD. RESULTS In the adjusted model, there was a significant association between increasing log-transformed maternal 25(OH)D levels and decreasing risk of offspring ASD (adjusted odds ratio [aOR] 0.75, 95% confidence interval [CI] 0.62-0.92, p = .005). Analyses by quintiles of maternal 25(OH)D levels revealed increased odds for ASD in the 2 lowest quintiles, <20 (aOR 1.36, 95% CI 1.03-1.79, p = .02) and 20-39 (aOR 1.31, 95% CI 1.01-1.70, p = .04), compared with the highest quintile. The increased risk of ASD was observed in association with deficient (<30 nmol/L) (aOR 1.44, 95% CI 1.15-1.81, p = .001) and insufficient (30-49.9 nmol/L) maternal 25(OH)D levels (aOR 1.26, 95% CI 1.04-1.52, p = .01) compared with sufficient levels. CONCLUSIONS This finding has implications for understanding the role of maternal vitamin D during fetal brain development and increased risk of ASD.
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Affiliation(s)
- Andre Sourander
- Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Turku, Finland; INVEST (Inequalities, Interventions and a New Welfare State) Research Flagship, University of Turku, Turku, Finland; Department of Child Psychiatry, Turku University Hospital, Turku, Finland; New York State Psychiatric Institute, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.
| | - Subina Upadhyaya
- Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Heljä-Marja Surcel
- Faculty of Medicine, University of Oulu, Oulu, Finland; Biobank Borealis of Northern Finland, Oulu, Finland
| | | | - Keely Cheslack-Postava
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Sanju Silwal
- Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Minna Sucksdorff
- Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Turku, Finland; Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Ian W McKeague
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Alan S Brown
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Sucksdorff M, Brown AS, Hinkka-Yli-Salomäki S, Cheslack-Postava K, Sourander A. Dr. Sucksdorff et al. Reply. J Am Acad Child Adolesc Psychiatry 2021; 60:1167-1168. [PMID: 33961986 DOI: 10.1016/j.jaac.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
We thank Trivedi et al. for their letter1 raising valuable questions regarding a clinical viewpoint on the observed association between maternal vitamin D levels in early pregnancy and offspring risk of attention-deficit/hyperactivity disorder (ADHD) in our study.2 We are happy that our research has raised discussion and are grateful for the opportunity to reply.
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Upadhyaya S, Sourander A, Luntamo T, Matinolli HM, Chudal R, Hinkka-Yli-Salomäki S, Filatova S, Cheslack-Postava K, Sucksdorff M, Gissler M, Brown AS, Lehtonen L. Preterm Birth Is Associated With Depression From Childhood to Early Adulthood. J Am Acad Child Adolesc Psychiatry 2021; 60:1127-1136. [PMID: 33068750 DOI: 10.1016/j.jaac.2020.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 09/14/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There have been inconsistent findings on the associations among prematurity, poor fetal growth, and depression. We examined the associations among gestational age, poor fetal growth, and depression in individuals aged 5 to 25 years. METHOD We identified 37,682 case subjects based on International Classification of Diseases, Ninth Revision code 2961 and International Classification of Diseases, Tenth Revision codes F32.0-F32.9 and F33.0-F33.9 from the Care Register for Health Care, and 148,795 matched controls from the Finnish Central Population Register. Conditional logistic regression examined the associations between gestational age by each gestational week, poor fetal growth, and depression. The associations were adjusted for parental age and psychopathology, paternal immigrant status, maternal substance abuse, depression, number of previous births, marital status, socio-economic status, smoking during pregnancy, and the infant's birthplace. RESULTS In the adjusted models, increased risk of depression was found in children born ≤25 weeks (adjusted odds ratio [aOR] 1.89, 95% CI 1.08-3.31), at 26 weeks (aOR 2.62, 95% CI 1.49-4.61), at 27 weeks (aOR 1.93, 95% CI 1.05-3.53), and ≥42 weeks (aOR 1.11, 95% CI 1.05-1.19). In girls, extremely preterm birth was associated with depression diagnosed at 5 to 12 years (aOR 2.70, 95% CI 1.83-3.98) and 13 to 18 years (aOR 2.97, 95% CI 1.84-4.78). In boys, postterm birth (≥42 weeks) was associated with depression diagnosed at 19 to 25 years (aOR 1.28, 95% CI 1.07-1.54). Poor fetal growth was associated with an increased risk of depression in full-term infants (aOR 1.06, 95% CI 1.03-1.10) and postterm infants (aOR 1.24, 95% CI 1.08-1.43). CONCLUSION Preterm birth before 28 weeks of gestation appeared to play a role in the development of childhood depression. Smaller effects were also seen in postterm births, especially in boys.
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Affiliation(s)
| | - Andre Sourander
- University of Turku, Finland; Turku University Hospital, Finland; Columbia University, New York.
| | | | - Hanna-Maria Matinolli
- University of Turku, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | | | | | - Mika Gissler
- University of Turku, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland; Karolinska Institute, Stockholm, Sweden
| | | | - Liisa Lehtonen
- University of Turku, Finland; Turku University Hospital, Finland
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Upadhyaya S, Chudal R, Luntamo T, Hinkka‐Yli‐Salomäki S, Sucksdorff M, Lehtonen L, Sourander A. Perinatal risk factors and reactive attachment disorder: A nationwide population-based study. Acta Paediatr 2020; 109:1603-1611. [PMID: 31899934 DOI: 10.1111/apa.15156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 11/28/2022]
Abstract
AIM To examine the association between several perinatal and obstetric risk factors and reactive attachment disorder in children diagnosed in specialised services. METHODS In this nested case-control study, 614 cases with reactive attachment disorder and 2423 controls matched with age and sex were identified from Finnish national registers. Conditional logistic regression was used to examine the association between a number of perinatal risk factors and reactive attachment disorder. RESULTS In the adjusted analysis, a low birthweight of <2500 g was associated with an increased odds of reactive attachment disorder, with an odds ratio (OR) of 1.96 and 95% confidence interval (CI) of 1.17, 3.30 and a birthweight of 4000-4499 grams was associated with decreased odds OR 0.49 (95% CI 0.31, 0.75). The odds for being diagnosed with reactive attachment disorder increased with a gestational age of <32 weeks OR 3.72 (95% CI 1.52, 9.10), induced labour OR 1.34 (95% CI 1.03, 1.75) and monitoring in a neonatal intensive care unit (NICU) OR 1.67 (95% CI 1.09, 2.55). CONCLUSION We found associations between low birthweight, preterm birth, NICU admission and reactive attachment disorder. The findings add to the current literature on the understanding of the development of reactive attachment disorder in children.
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Affiliation(s)
- Subina Upadhyaya
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | - Roshan Chudal
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | - Terhi Luntamo
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | | | - Minna Sucksdorff
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | - Liisa Lehtonen
- Department of Paediatrics Turku University Hospital Turku Finland
- Department of Paediatrics University of Turku Turku Finland
| | - Andre Sourander
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
- Department of Child Psychiatry Turku University Hospital Turku Finland
- INVEST Research Flagship University of Turku Turku Finland
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Sourander A, Sucksdorff M, Chudal R, Surcel HM, Hinkka-Yli-Salomäki S, Gyllenberg D, Cheslack-Postava K, Brown AS. Prenatal Cotinine Levels and ADHD Among Offspring. Pediatrics 2019; 143:e20183144. [PMID: 30804074 PMCID: PMC6398365 DOI: 10.1542/peds.2018-3144] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES An association between maternal smoking during pregnancy and offspring attention-deficit/hyperactivity disorder (ADHD) has been shown across several studies based on self-reports. No previous studies have investigated the association of nicotine exposure measured by cotinine levels during pregnancy and offspring ADHD. METHODS In this population-based study, 1079 patients born between 1998 and 1999 and diagnosed with ADHD according to the International Classification of Diseases and 1079 matched controls were identified from Finnish nationwide registers. Maternal cotinine levels were measured by using quantitative immunoassays from maternal serum specimens collected during the first and second trimesters of pregnancy and archived in the national biobank. RESULTS There was a significant association between increasing log-transformed maternal cotinine levels and offspring ADHD. The odds ratio was 1.09 (95% confidence interval [CI] 1.06-1.12) when adjusting for maternal socioeconomic status, maternal age, maternal psychopathology, paternal age, paternal psychopathology, and child's birth weight for gestational age. In the categorical analyses with cotinine levels in 3 groups, heavy nicotine exposure (cotinine level >50 ng/mL) was associated with offspring ADHD, with an odds ratio of 2.21 (95% CI 1.63-2.99) in the adjusted analyses. Analyses by deciles of cotinine levels revealed that the adjusted odds for offspring ADHD in the highest decile was 3.34 (95% CI 2.02-5.52). CONCLUSIONS The study reveals an association with and a dose-response relationship between nicotine exposure during pregnancy and offspring ADHD. Future studies incorporating maternal smoking and environmental, genetic, and epigenetic factors are warranted.
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Affiliation(s)
- Andre Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland;
- Departments of Child Psychiatry and
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Minna Sucksdorff
- Department of Child Psychiatry, University of Turku, Turku, Finland
- Pediatric and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Roshan Chudal
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Heljä-Marja Surcel
- Faculty of Medicine, Medical Research Center, University of Oulu, Oulu, Finland
- Biobank Borealis of Northern Finland, Oulu University Hospital, Oulu, Finland
| | | | - David Gyllenberg
- Department of Child Psychiatry, University of Turku, Turku, Finland
- National Institutes of Health and Welfare, Helsinki, Finland
- Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland; and
| | - Keely Cheslack-Postava
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Alan S Brown
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Sucksdorff M, Lehtonen L, Chudal R, Suominen A, Gissler M, Sourander A. Lower Apgar scores and Caesarean sections are related to attention-deficit/hyperactivity disorder. Acta Paediatr 2018; 107:1750-1758. [PMID: 29604108 DOI: 10.1111/apa.14349] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/15/2018] [Accepted: 03/26/2018] [Indexed: 12/31/2022]
Abstract
AIM We examined the associations between prenatal, birth-related and newborn risk factors and attention-deficit/hyperactivity disorder (ADHD). METHODS In this population-based study, 10 409 subjects diagnosed with ADHD by 31 December 2011 and 39 124 controls, born between 1 January 1991 and 31 December 2005, were identified from Finnish nationwide registers. Perinatal data were obtained from the Birth Register. Conditional logistic regression was used to examine the associations after controlling for confounders. RESULTS Lower Apgar scores were associated with a higher risk of ADHD, with odds ratios of 1.12 (95% confidence intervals 1.06-1.19) for one-minute Apgar scores of 7-8, 1.17 (95% CI 1.02-1.35) for scores of 5-6 and 1.41 (95% CI 1.18-1.68) for scores of 0-4, compared to Apgar scores of 9-10. Elective Caesarean sections were associated with an increased risk of ADHD with an adjusted odds ratio of 1.15 (95% CI 1.05-1.26). Other identified risk factors were breech presentation, induced labour and admission to a neonatal intensive care unit. Low umbilical artery pH did not increase the risk of ADHD. CONCLUSION Elective Caesareans and perinatal adversities leading to lower Apgar scores increased the risk of ADHD. Future research to identify the mechanisms behind these findings is warranted.
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Affiliation(s)
- Minna Sucksdorff
- Department of Child Psychiatry; University of Turku; Turku Finland
- Department of Pediatrics; Turku University Hospital; Turku Finland
| | - Liisa Lehtonen
- Department of Pediatrics; Turku University Hospital; Turku Finland
- Department of Pediatrics; University of Turku; Turku Finland
| | - Roshan Chudal
- Department of Child Psychiatry; University of Turku; Turku Finland
| | - Auli Suominen
- Department of Child Psychiatry; University of Turku; Turku Finland
| | - Mika Gissler
- Department of Child Psychiatry; Turku University Hospital; Turku Finland
- National Institute for Health and Welfare; Helsinki Finland
- Karolinska Institute; Stockholm Sweden
| | - Andre Sourander
- Department of Child Psychiatry; University of Turku; Turku Finland
- Department of Child Psychiatry; Turku University Hospital; Turku Finland
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Arrhenius B, Gyllenberg D, Chudal R, Lehti V, Sucksdorff M, Sourander O, Virtanen JP, Torsti J, Sourander A. Social risk factors for speech, scholastic and coordination disorders: a nationwide register-based study. BMC Public Health 2018; 18:739. [PMID: 29902994 PMCID: PMC6002992 DOI: 10.1186/s12889-018-5650-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 05/31/2018] [Indexed: 01/24/2023] Open
Abstract
Background Broadly defined learning and coordination disorders (LCDs) are common in the population and have previously been associated with familial social risk factors and male sex. However, comprehensive nationwide studies of these risk factors in LCD subgroups are lacking. Our objective was to assess different LCDs in relation to sex and maternal education, marital status and socioeconomic status based on occupation. Methods We conducted a nationwide register-based study. The following diagnoses were identified from the Finnish Hospital Discharge Register (FHDR) according to the ICD-10 (n = 28,192): speech disorders (F80), scholastic disorders (F81), motor and coordination disorders (F82) and mixed developmental disorder (F83). To study cumulative incidence and male: female ratios of service use of LCDs, we used a cohort design among all Finnish children born singleton 1996–2007 (n = 690,654); to study social risk factors, we used a nested case-control design with extensive register data on both cases and matched controls (n = 106,616). Results The cumulative incidence was 4.7% for any LCD by age 15 and the changes in cumulative incidence over time were minor. The male: female ratios were 2.2–3.0 across LCD subgroups. Learning and coordination disorders were more common in households with lower maternal education, socioeconomic status based on occupation and among children with single mothers at the time of birth; the odds ratios (OR) for any LCD were 1.2–1.9 across risk factors. The odds for LCD diagnosis increased linearly with the number of social risk factors, except for coordination disorder. The effect size of three risk factors was highest in the group with mixed or multiple LCDs; OR 3.76 (95% CI 3.31–4.28). Conclusions Multiple social risk factors increase the odds for multiple, more comprehensive learning difficulties. The findings have implications for service planning, as early identification and interventions of learning and coordination disorders might reduce related long-term social adversities. Electronic supplementary material The online version of this article (10.1186/s12889-018-5650-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bianca Arrhenius
- Child and Youth Health Services, City of Helsinki, Helsinki, Finland. .,Research Center for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland.
| | - David Gyllenberg
- National Institute for Health and Welfare, Helsinki, Finland.,Research Center for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland
| | - Roshan Chudal
- Research Center for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland
| | - Venla Lehti
- Department of Psychiatry, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Helsinki, Finland.,Research Center for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland
| | - Minna Sucksdorff
- Department of Pediatrics, Turku University Hospital, Turku, Finland.,Research Center for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland
| | - Ona Sourander
- Research Center for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland
| | - Juha-Pekka Virtanen
- Research Center for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland
| | - Jutta Torsti
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Andre Sourander
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland.,Research Center for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland
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Sucksdorff M, Lehtonen L, Chudal R, Suominen A, Joelsson P, Gissler M, Sourander A. Preterm Birth and Poor Fetal Growth as Risk Factors of Attention-Deficit/ Hyperactivity Disorder. Pediatrics 2015; 136:e599-608. [PMID: 26304830 DOI: 10.1542/peds.2015-1043] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Previous studies have shown an association between prematurity and attention- abstract deficit/hyperactivity disorder (ADHD). Results concerning late preterm infants are controversial, and studies examining fetal growth represented by weight for gestational age are scarce. Our objective was to examine the association between gestational age by each week of fetal maturity, weight for gestational age, and ADHD. METHODS In this population-based study, 10 321 patients with ADHD, diagnosed according to the International Classification of Diseases and 38 355 controls individually matched for gender, date and place of birth, were identified from Finnish nationwide registers. Perinatal data were obtained from the Finnish Medical Birth Register. Conditional logistic regression was used to examine the association between gestational age, weight for gestational age, and ADHD after controlling for confounding factors. RESULTS The risk of ADHD increased by each declining week of gestation. The associations were robust after adjusting for confounders. An elevated risk also was seen among late preterm and early term infants. As for fetal growth, the odds ratio showed a U-shaped curve with an increased risk seen when the weight for gestational age was 1 SD below and 2 SD above the mean. CONCLUSIONS Our findings suggest that each gestational week has significance for child's subsequent neurodevelopment and risk for ADHD. We also showed that poor fetal growth increased the risk of ADHD. This highlights the importance of taking into account both prematurity and poor fetal growth when planning the timing of birth as well as later follow-up and support policies.
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Affiliation(s)
- Minna Sucksdorff
- Departments of Child Psychiatry, and
- Departments of Pediatrics, and
| | - Liisa Lehtonen
- Departments of Pediatrics, and
- Pediatrics, University of Turku, Turku, Finland
| | | | | | | | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland; and
- Nordic School of Public Health, Gothenburg, Sweden
| | - Andre Sourander
- Departments of Child Psychiatry, and
- Child Psychiatry, Turku University Hospital, Turku, Finland
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