臺灣剖腹產和妊娠期糖尿病與子代注意力不足過動症風險之相關性

The Association of Cesarean Section and Maternal Diabetes with Risk of Attention Deficit Hyperactivity Disorder Among Offspring in Taiwan.

李旻珊(Min-Shan Li)

指導教授 ： 江東亮

共同指導教授 ： 陳映燁(Ying-yeh Chen)

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2022年)

https://doi.org/10.6342/NTU202203419

摘要

背景：注意力不足過動症為常在兒童時期發生的神經心理疾病，目前有逐年增加趨勢，此疾病對於病童、家屬和社會造成的負面影響深遠。
目的：過去文獻顯示：剖腹產和妊娠期糖尿病和子代注意力不足過動症有相關性，本研究欲探討在臺灣兩者是否會增加子代注意力不足過動症風險。
方法：本回溯式世代研究以臺灣國民健康保險研究數據庫的資料作分析，追蹤2004年登記於出生通報檔的新生兒共137,020名，追蹤此研究族群至2016年為止是否曾被診斷為注意力不足過動症，並以迴歸分析去評估暴露因子剖腹產與妊娠期糖尿病是否會增加子代注意力不足過動症風險。
結果：在平均12.2年的追蹤中，共有8,075名（5.89%）兒童被診斷有注意力不足過動症，其中26,835名（19.6%）透過剖腹產分娩，819名（0.6%）兒童曾暴露於妊娠期糖尿病（134名妊娠糖尿病，685名孕前糖尿病）。與陰道分娩相比，剖腹產伴隨著較高的注意力不足過動症風險（調整後風險比：1.39，95%信賴區間：1.32-1.46）。妊娠糖尿病沒有增加子代注意力不足過動症風險（調整後風險比：0.97，95%信賴區間：0.50-1.86），但孕前糖尿病會增加子代注意力不足過動症風險（調整後風險比：1.40，95%信賴區間：1.09-1.80）。
結論：本研究顯示剖腹產和孕前糖尿病會增加子代注意力不足過動症風險。

關鍵字

注意力不足過動症 ； 剖腹產 ； 妊娠期糖尿病 ； 妊娠糖尿病 ； 孕前糖尿病

並列摘要

Objectives: Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder that mostly occurs in early childhood. A trend of increasing prevalence is noted, while the impact of ADHD along the life course is substantial. Recent literature has shown that maternal diabetes and cesarean section (C/S) may be correlated with children's attention deficit disorder or ADHD, the present study thus we aimed to explore the relationship between these two factors and childhood ADHD.
Methods: The data source of this retrospective birth cohort study came from the Taiwan National Health Insurance Research Database, including Birth Certificate Application and Maternal and Child Health Database. Nationwide registries were used to link data of all live births in Taiwan in 2004 (n= 137,020). Cox proportional hazards modeling was applied to estimate the effect of delivery mode, as well as maternal diabetes, on the outcomes of offspring ADHD, adjusting for potential confounders.
Results: During a median of 12.2 years of follow-up, 8,075 (5.89%) children were diagnosed with ADHD. A total of 26,835 (19.6%) children were delivered by C/S. 819 (0.6%) children were exposed to maternal diabetes, while 134 (0.1%) exposed to gestational diabetes mellitus (GDM) and 685(0.5%) to pre-existing diabetes mellitus (PDM). Compared with children delivered by vaginal delivery, greater ADHD risk was observed among those delivered by C/S, with adjusted hazard ratio 1.39 (95% CI:1.32-1.46). During the follow up, the adjusted hazard ratio for ADHD in children was 1.40 (95% CI:1.09-1.80) for exposure to PDM. However, ADHD risk was not associated with GDM (adjusted hazard ratio=0.97, 95% CI:0.50-1.86).
Conclusions: The result of this study supports the statement that C/S and PDM influence the risk of ADHD in offspring in Taiwan.

並列關鍵字

attention deficit hyperactivity disorder ； cesarean section ； maternal diabetes ； gestational diabetes mellitus ； pre-existing diabetes mellitus

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