The maternal prepregnancy body mass index and the risk of attention deficit hyperactivity disorder among children and adolescents: a systematic review and meta-analysis원문보기논문타임라인
Jenabi, Ensiyeh
(Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences)
,
Bashirian, Saied
(Social Determinants of Health Research Center, Hamadan University of Medical Sciences)
,
Khazaei, Salman
(Research Center for Health Sciences, Hamadan University of Medical Sciences)
,
Basiri, Zohreh
(Science Epidemiology, Faculty of Science, University of Melbourne)
Background: Attention deficit hyperactivity disorder (ADHD) symptoms have a major impact on individuals, families, and society. Therefore identification risk factors of ADHD are a public health priority. Purpose: This is meta-analysis evaluated the association between maternal prepregnancy body mass...
Background: Attention deficit hyperactivity disorder (ADHD) symptoms have a major impact on individuals, families, and society. Therefore identification risk factors of ADHD are a public health priority. Purpose: This is meta-analysis evaluated the association between maternal prepregnancy body mass index and the risk of ADHD among the resulting offspring. Methods: The search identified studies published through December 2018 in the PubMed, Web of Science, and Scopus databases. The odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CI) extracted from eligible studies were used as the common measure of association among studies. Results: A significant association was found between overweight women and the risk of ADHD among children with the pooled HR and OR estimates (HR, 1.27 and 95% CI, 1.17-1.37; OR, 1.28 and 95% CI, 1.15-1.40, respectively). This association was significant between obese women and the risk of ADHD among children and adolescents with the pooled estimates of HR and OR (HR, 1.65 and 95% CI, 1.55-1.76; OR, 1.42 and 95% CI, 1.23-1.61). Conclusion: The current epidemiological studies present sufficient evidence that prepregnancy overweight and obesity are significantly associated with an increased risk of ADHD among children and adolescents. These findings provide a new approach to preventing ADHD by controlling weight gain in the prenatal period, which should be considered by policymakers.
Background: Attention deficit hyperactivity disorder (ADHD) symptoms have a major impact on individuals, families, and society. Therefore identification risk factors of ADHD are a public health priority. Purpose: This is meta-analysis evaluated the association between maternal prepregnancy body mass index and the risk of ADHD among the resulting offspring. Methods: The search identified studies published through December 2018 in the PubMed, Web of Science, and Scopus databases. The odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CI) extracted from eligible studies were used as the common measure of association among studies. Results: A significant association was found between overweight women and the risk of ADHD among children with the pooled HR and OR estimates (HR, 1.27 and 95% CI, 1.17-1.37; OR, 1.28 and 95% CI, 1.15-1.40, respectively). This association was significant between obese women and the risk of ADHD among children and adolescents with the pooled estimates of HR and OR (HR, 1.65 and 95% CI, 1.55-1.76; OR, 1.42 and 95% CI, 1.23-1.61). Conclusion: The current epidemiological studies present sufficient evidence that prepregnancy overweight and obesity are significantly associated with an increased risk of ADHD among children and adolescents. These findings provide a new approach to preventing ADHD by controlling weight gain in the prenatal period, which should be considered by policymakers.
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문제 정의
Thus, the status of this association is uncertain. Accordingly, the current meta-analysis aimed to investigate the association between maternal prepregnancy BMI and offspring ADHD.
제안 방법
There are also a number of limitations that should be considered. First, this meta-analysis was based on observational studies, the design of which is associated with inherent biases. Second, BMI measured in 4 studies was based on self-reports; thus, their validity is questionable.
The datasheet used for the extraction included publication year, first author, country, study design, maternal prepregnancy BMI and ADHD, diagnostic criteria of ADHD, sample size, hazard ratio (HR) and rate ratio (RR) and their associated 95% confidence intervals (CI), adjustment, child’s age, and study quality.
The search identified studies published until December 2018 in the PubMed, Web of Science, and Scopus databases. The search was performed using the following principal terms categorized in 2 groups: (1) ADHD, attention deficit disorder with hyperactivity, attention deficit disorder hyperactivity, attention deficit disorder hyperactivity, child attention deficit disorder; and (2) body size, obese, obesity, overweight, BMI, and prepregnancy (or prepregnancy).
Second, BMI measured in 4 studies was based on self-reports; thus, their validity is questionable. Third, the studies included in this meta-analysis were conducted in the USA and European countries, which might introduce data bias to this meta-analysis assessing the relationship between ADHD and prepregnancy BMI. This knowledge about the association between maternal overweight/ obesity and ADHD among children and adolescents can lead to an early assessment of children at risk and improve the methods of early diagnosis and intervention.
대상 데이터
In the next stage, 322 papers were excluded after the title and abstract screening and 9 papers were excluded after the full-text screening. Finally, 10 papers9,10,16-23) with a total of 1,464,097 participants were included in the analysis. All studies were of cohort design.
In the primary search, 505 studies were identified. Of them, we excluded 166 duplicate papers.
데이터처리
Publication bias was assessed using the Begg and Egger’s regression model.15) The statistical meta-analysis was performed using Stata ver. 13 (Stata Corp., College Station, TX, USA).
이론/모형
All studies in this meta-analysis had high methodology quality according to the Newcastle-Ottawa Scale (Table 1).
성능/효과
The pooled results based on ORs of the teacher/parent-identified ADHD symptoms and overweight women studies were 1.33 (95% CI, 0.95–1.70) and 1.26 (95% CI, 1.12–1.41), while those in obese women were 1.42 (95% CI, 0.70–2.13) and 1.47 (95% CI, 1.25–1.68), respectively.
This association was significant between obese women and risk of ADHD among children and adolescents based on the pooled estimates of HR and OR, respectively (HR, 1.65 and 95% CI, 1.55–1.76; OR, 1.42 and 95% CI, 1.23–1.61) (Fig. 3).
We found a statistically significant association between prepregnancy overweight and obesity and an increased risk of ADHD among children based on the pooled estimates of both HR and OR. This study showed that the risk of offspring ADHD increased by about 30% in women with prepregnancy overweight status 42% and 65% in women with prepregnancy obesity according to OR and HR, respectively. In the subgroup analysis, there was no significant association in teacher-rated ADHD symptoms in the offsprings of overweight and obese women.
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