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期刊来源：Nat Med

原文链接：https://doi.org/10.1038/s41591-024-02917-8

摘要内容如下：

先前的研究报道了母亲糖尿病（MDM）和注意力缺陷/多动障碍（ADHD）之间的联系，通常忽略了未测量的混杂因素，如共同的遗传和环境因素。因此，我们在香港、新西兰、台湾、芬兰、冰岛、挪威和瑞典进行了一项多国队列研究，使用Cox比例风险回归评估不同MDM（任何MDM、妊娠期糖尿病（GDM）和孕前糖尿病（PGDM））与ADHD之间的关联。我们在2001年至2014年期间纳入了360多万对母子，并随访至2020年。与未暴露的儿童相比，妊娠期间患有任何类型糖尿病的母亲所生的儿童患ADHD的风险更高（合并风险比（HR）=1.16，95%置信区间（CI）=1.08-1.24）。GDM（合并HR=1.10，95%CI=1.04-1.17）和PGDM（合并HR=1.39，95%CI=1.25-1.55）患ADHD的风险也较高。然而，在孕期不一致暴露于GDM的同胞具有相似的ADHD风险（合并HR=1.05，95%CI=0.94-1.17），提示未测量的、共享的家族因素的潜在混杂。我们的研究结果表明，MDM和ADHD之间存在小到中等程度的关联，而GDM和ADHD之间的关联不太可能是因果关系。这一发现与先前的研究形成了鲜明的对比，先前的研究报告了相当高的风险估计值，并强调需要重新评估高血糖和遗传因素在MDM和ADHD之间关系中的确切作用。

英文原文如下：

Abstracts

Previous studies report an association between maternal diabetes mellitus (MDM) and attention-deficit/hyperactivity disorder (ADHD), often overlooking unmeasured confounders such as shared genetics and environmental factors. We therefore conducted a multinational cohort study with linked mother-child pairs data in Hong Kong, New Zealand, Taiwan, Finland, Iceland, Norway and Sweden to evaluate associations between different MDM (any MDM, gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM)) and ADHD using Cox proportional hazards regression. We included over 3.6 million mother-child pairs between 2001 and 2014 with follow-up until 2020. Children who were born to mothers with any type of diabetes during pregnancy had a higher risk of ADHD than unexposed children (pooled hazard ratio (HR) = 1.16, 95% confidence interval (CI) = 1.08-1.24). Higher risks of ADHD were also observed for both GDM (pooled HR = 1.10, 95% CI = 1.04-1.17) and PGDM (pooled HR = 1.39, 95% CI = 1.25-1.55). However, siblings with discordant exposure to GDM in pregnancy had similar risks of ADHD (pooled HR = 1.05, 95% CI = 0.94-1.17), suggesting potential confounding by unmeasured, shared familial factors. Our findings indicate that there is a small-to-moderate association between MDM and ADHD, whereas the association between GDM and ADHD is unlikely to be causal. This finding contrast with previous studies, which reported substantially higher risk estimates, and underscores the need to reevaluate the precise roles of hyperglycemia and genetic factors in the relationship between MDM and ADHD.

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