导致儿童注意力缺陷多动障碍的孕期和围产期危险因素Scoping综述

doi:10.3969/j.issn.1006-9771.2022.01.012

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (1): 79-89.doi: 10.3969/j.issn.1006-9771.2022.01.012

导致儿童注意力缺陷多动障碍的孕期和围产期危险因素Scoping综述

支金草¹,张世雯¹,黄美灵¹,裴飞²,王艳²()

1.黑龙江中医药大学,黑龙江哈尔滨市 150040
2.黑龙江中医药大学附属第二医院,黑龙江哈尔滨市 150001

收稿日期:2021-10-08 修回日期:2021-12-27 出版日期:2022-01-25 发布日期:2022-02-11
通讯作者: 王艳 E-mail:swallow1113@163.com
作者简介:支金草(1998-),女,汉族,河南漯河市人,硕士研究生,主要研究方向：儿童康复的临床及基础研究。
基金资助:
黑龙江中医药大学"优秀创新人才支持计划"科研项目(2018RCL10)

Risk factors during pregnancy and perinatal period for attention deficit hyperactivity disorder in children: a scoping review

ZHI Jincao¹,ZHANG Shiwen¹,HUANG Meiling¹,PEI Fei²,WANG Yan²()

1. Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, China
2. Second Hospital Affiliated to Heilongjiang University of Traditional Chinese Medicine, Harbin, Heilongjiang 150001, China

Received:2021-10-08 Revised:2021-12-27 Published:2022-01-25 Online:2022-02-11
Contact: WANG Yan E-mail:swallow1113@163.com
Supported by:
Heilongjiang University of Chinese Medicine Excellent Innovation Talents Research Projects(2018RCL10)

摘要/Abstract

摘要：

目的对导致儿童注意力缺陷多动障碍(ADHD)的孕期和围产期相关危险因素进行Scoping综述。方法检索中国知网、万方数据库、PubMed和Web of Science儿童ADHD的孕期和围产期危险因素相关的文献,时间为建库至2021年7月1日,提取作者、国家、发表时间、研究对象、年龄、样本量、纳入时间、研究设计、诊断标准、评价工具和相关危险因素。结果共检索到文献2 721篇,最终纳入35篇,来自11个国家,多数文献来源于儿科学、精神病学、神经病学及流行病学相关主题期刊,研究主要集中在2008年至2021年,研究方法大多数采用病例对照研究和队列研究,研究主要涉及儿童ADHD诊断方法、孕期及围产期危险因素评价方法和相关危险因素。儿童ADHD的诊断标准主要采用《精神疾病诊断与统计手册》和《国际疾病分类标准》,结合父母和老师用调查问卷做出最终诊断。孕期及围产期危险因素是从医疗记录中提取生产记录、出生记录、母亲病史记录、围产期住院和门诊记录和孕期母亲药物使用记录中的信息,或采用问卷调查法(父母/新生儿)汇总信息。孕期及围产期危险因素主要分为孕期自身因素、宫内因素、环境因素和围产期意外四个方面,其中孕期自身因素包括孕妇低龄、妊娠期肥胖、孕期不良生活习惯、孕期有害物质暴露、孕期病史和孕期营养素缺乏;宫内因素包括宫内胎儿发育不佳、流产和怀孕次数;环境因素包括生活环境和社会环境;围产期意外包括分娩意外和新生儿健康状况不佳。结论导致儿童ADHD相关的孕期和围产期危险因素主要包括母体自身因素、宫内因素、环境因素和围产期意外四个方面。其中,孕期心理健康状况不佳是导致儿童ADHD的主要危险因素。

关键词: 注意力缺陷多动障碍, 儿童, 孕期, 围产期, 危险因素, Scoping综述

Abstract:

Obective To analyze the risk factors during pregnancy and perinatal period leading to attention deficit hyperactivity disorder (ADHD) in children using scoping review. Methods The literatures related to the risk factors of children's ADHD during pregnancy and perinatal period were searched from CNKI, Wanfang Data, PubMed and Web of Science, from the establishment to July 1st, 2021. The content of author, country, publication time, research object, age, sample size, inclusion time, study design, diagnostic criteria, evaluation tools and related risk factors were extracted. Results A total of 2 721 articles were returned, and 35 articles were finally included, from eleven countries. Most of the articles came from journals related to pediatrics, psychiatry, neurology and epidemiology. The researches were mainly concentrated from 2008 to 2021, mainly were controlled studies and cohort studies. The researches mainly involved the methods of diagnosis, evaluation of risk factors during pregnancy and perinatal period, and related risk factors. The diagnostic criteria of ADHD mainly were the Diagnostic and Statistical Manual of Mental Disorders and International Disease Classification Standards, combined with the questionnaires used by parents and teachers to make the final diagnosis. The risk factors during pregnancy and perinatal period were extracted from medical records of birth, birth records, maternal medical history, perinatal hospitalization and outpatient records, and maternal drug use records during pregnancy, or questionnaire survey (parents/newborns). The risk factors for ADHD in children during pregnancy and perinatal period might be divided into four aspects: maternal factors, intrauterine factors, environmental factors and perinatal accidents. Among them, the maternal factors included young mother, obesity, poor living behavior, substance exposure, medical history, and nutrient deficiency during pregnancy; intrauterine factors included poor fetal development in the mother's uterus, miscarriages and the number of pregnancies; environmental factors included living environment and social environment; perinatal accidents included childbirth accidents and poor health of newborns. Conclusion The pregnancy and perinatal risk factors related to ADHD in children mainly include maternal factors, intrauterine factors, environmental factors and perinatal accidents. The poor mental health of mothers during pregnancy is the main risk factor leading to children's ADHD.

Key words: attention deficit hyperactivity disorder, children, pregnancy, perinatal period, risk factors, scoping review

中图分类号:

R749.93

支金草,张世雯,黄美灵,裴飞,王艳. 导致儿童注意力缺陷多动障碍的孕期和围产期危险因素Scoping综述[J]. 《中国康复理论与实践》, 2022, 28(1): 79-89.

ZHI Jincao,ZHANG Shiwen,HUANG Meiling,PEI Fei,WANG Yan. Risk factors during pregnancy and perinatal period for attention deficit hyperactivity disorder in children: a scoping review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(1): 79-89.

图/表 2

图1

表1

纳入文献的一般资料"

文献	国家	研究对象	年龄/岁	样本量 (T/C)/n	时间	研究设计	诊断标准	评价工具	危险因素
李焱等^[10](2020)	中国	ADHD儿童	6~16	132/82	出生后	病例对照研究	DSM-Ⅴ;儿童精神障碍调查筛查及半定式诊断检查表;WISC-IV	一般情况调查表;父母压力指数问卷(PSI)	母体因素：孕期生病、吸烟、酗酒宫内因素：脐带绕颈、怀孕次数环境因素：夫妻关系不和、家庭成员丧生围产期意外：出生性窒息、难产
郭明等^[11](2009)	中国	四年级学生	9~11(10.05)	37/596	出生后	横断面病例对照研究	Conners问卷(家长及教师用问卷);中国精神障碍分类与诊断标准第3版	家庭危险因素调查表	母体因素：母孕期心理创伤环境因素：家庭关系欠佳围产期意外：分娩方式(难产/剖腹产)、孕期长短(早产/过期产)
张碧昌等^[12](2011)	中国	中小学生	11.05	22/2 994	出生后	随机抽样调查	PSQ;病史询问;智力测试;DSM-IV	自编问卷;儿童个人及家庭社会情况调查表	母体因素：孕期情绪低落环境因素：父母关系不和
张玉等^[13](2017)	中国	小学生	5~16(9.73±1.80)	468/9 160	出生后	分层整群随机抽样	问卷筛查;诊断访谈(SNAP -IV量表);DSM-IV	问卷;访谈	母体因素：母孕期身体健康状况、心理健康状况不佳、生育年龄围生期意外：出生时健康状况环境因素：父母关系不好
张丽珊等^[14](2009)	中国	ADHD儿童	6~9(8.19±1.92)	720/1 576	出生后	病例对照研究	DSM-IV	调查问卷	母体因素：母亲吸烟史、母亲产后及孕期情绪低落环境因素：父母婚姻关系(不和、离婚)
吴丽慧等^[15](2004)	中国	小学生	10.23	203/203	出生后	病例对照研究	TRS教师用量表;PSQ;DSM-IV	家庭因素问卷调查	母体因素：母亲孕期精神创伤、孕期焦虑、母亲血型宫内因素：单双胎环境因素：夫妻关系不和
高宇等^[16](2008)	中国	剖宫产儿童	14岁以下	226/181	出生后	病例回顾性研究	WISC;PSQ;CBCL(家长填写);DSM	病例生产记录	宫内因素：宫内窘迫、宫内发育迟缓围产期意外：剖宫产
Pineda等^[17](2003)	哥伦比亚	ADHD儿童	6~11	200/200	出生后	病例随机对照研究	标准化ADHD诊断	调查问卷(关于怀孕、分娩和新生儿期问题)	母体因素：严重流感发作(发热、无病毒)、吸烟、酗酒宫内因素：流产先兆围生期意外：早产、轻微先天性畸形、新生儿癫痫发作、新生儿期住院
Grizenko等^[18](2008)	加拿大	ADHD儿童	6~12	203	出生后	随机对照研究	DSM-IV-R;儿童诊断访谈时间表第四版;CBCL;Conners 家长全球指数;Conners的全球教师指数;WISC-III	Kinney 医学和妇科问卷;McNeil-Sjöstrom 量表	母体因素：产前压力
Watkins等^[19](2021)	墨西哥	宫内邻苯二甲酸酯暴露儿童	6~11	221	出生前	前瞻性重复测量研究(横断面)	CPT-2;CPT-3	孕期母体尿样测量邻苯二甲酸酯代谢物;访谈问卷	环境因素：宫内接触邻苯二甲酸酯
Watkins等^[19](2021)	墨西哥	宫内邻苯二甲酸酯暴露儿童	9~18	200	出生前	前瞻性重复测量研究(横断面)	CPT-2;CPT-3	孕期母体尿样测量邻苯二甲酸酯代谢物;访谈问卷	环境因素：宫内接触邻苯二甲酸酯
McCoy等^[20](2014)	瑞典	ADHD儿童	< 18	15 254	出生后	出生队列研究	ICD-9/10标准诊断	多代登记;国家患者登记;医疗出生登记;教育登记;健康保险和社会研究纵向整合数据库	母体原因：严重精神疾病围产期意外：低出生体质量、早产、小胎龄
Chu等^[21](2012)	中国	ADHD儿童	6~12	195/212	出生后	病例对照研究	DSM-IV-TR;WISC-III;临床总体印象严重程度评分	出生史记录	围产期意外：中度早产(胎龄33~37周)、低出生体质量(出生体质量< 2 500 g)
Linnet等^[22] (2005)	丹麦	ADHD儿童	2~8(5.46)	170/3 765	出生后	嵌套病例对照研究	ICD-10;DSM-IV;丹麦精神病学中心登记册	调查问卷;丹麦精神病学中心登记;丹麦医学出生登记;劳动力市场研究综合数据库;丹麦民事登记	母体因素：孕期吸烟
Chudal等^[23](2015)	芬兰	ADHD儿童	12	10 409/39 125	出生后	嵌套病例对照研究(队列研究)	ICD-10	芬兰出院登记、芬兰医疗出生登记、芬兰中央人口登记	母体因素：低龄(< 20岁)
Wang等^[24](2020)	丹麦	ADHD儿童	12.5	25 747	出生后	队列研究	ICD-10;3岁开始随访;医院登记和处方登记	ICD-8;ICD-10;母亲病史采集	宫内因素：母亲流产史
Linnet等^[25](2006)	丹麦	ADHD儿童	12	834/20 100	出生后	嵌套病例对照研究	ICD-10;ICD-8	丹麦精神病学中央登记、丹麦医疗出生登记、劳动力市场研究综合数据库、丹麦民事登记	围产期意外：早产(胎龄26~36周)、接近足月出生体质量低(1 500~2 499 g)
Getahun等^[26](2013)	美国	ADHD儿童	5~11	13 613/295 021	出生后	嵌套病例对照研究	随访期间接收了≥2张针对ADHD的处方	围产期服务系统记录、住院和门诊就诊记录;ICD-9-CM医疗记录	围产期意外：出生窒息、呼吸窘迫综合征、先兆子痫
Hanć等^[27](2018)	美国	ADHD儿童	6~18	132/146	出生后	病例对照研究(分级评估)	访谈;ICD-10;DSM-IV-TR	医疗登记处收集信息(胎儿、孕妇);父母问卷;新生儿健康评估(Apgar评分、出生时间和出生体质量);	围产期意外：Apgar评分下降、低出生体质量
Sucksdorff等^[28](2015)	芬兰	ADHD儿童	< 2	10 321/38 355	出生后	嵌套病例对照研究	ICD-9;ICD-10;DSM-IV	芬兰医疗出生登记、芬兰医院出院登记、芬兰中央人口登记	围产期意外：妊娠期短、早产宫内因素：胎儿发育不良
Sourander等^[29](2019)	芬兰	ADHD儿童	7.3	1 079/1 079	出生前	病例对照研究	ICD-8;ICD-10;DSM-IV	母亲孕期血清中可替宁水平;芬兰医疗出生登记、芬兰医院出院登记册、芬兰中央人口登记	环境因素：尼古丁暴露
Chen等^[30](2019)	中国	ADHD儿童	5	950/3 800	出生后	病例对照研究	ICD-9-CM	母亲乙酰氨基酚的使用情况	母体因素：乙酰氨基酚暴露
Modesto等^[31](2015)	荷兰	正常儿童	5~8	3 873	出生前	出生队列研究	Conners家长评分量表修订版;诊断性访谈	妊娠13.6周母体甲状腺激素水平;调查问卷和医疗记录提取信息	母体因素：低甲状腺素血症(宫内暴露于甲状腺激素水平不足)
Wolford等^[32](2017)	芬兰	正常儿童	3~6(3.8)	1 779	出生前	前瞻性队列研究	Conners多动指数(母亲填写);CBCL	BMI;抑郁量表;贝克抑郁量表-II;医疗记录提取母亲妊娠疾病(妊娠糖尿病、妊娠高血压)	母体因素：孕期母亲抑郁症状
Rodriguez^[33](2010)	瑞典	正常儿童	5	1 714	出生前	前瞻性妊娠-后代队列研究	DSM-IV;父母老师填写优势与困难问卷情绪评分	瑞典医学出生登记;母亲：生活事件压力调查问卷、爱丁堡产后抑郁量表、成人ADHD自我报告量表、DSM-IV	母体因素：产前超重或肥胖
Chen等^[34](2020)	中国	正常儿童	6.5	708 515	出生后	出生队列研究	ICD-9-CM	5个时期(怀孕前、怀孕期间和分娩后< 1、1~3和> 3年)评估父母亲抑郁症	母体因素：母亲抑郁环境因素：父亲抑郁
Fuemmeler等^[35](2019)	美国	正常儿童	2~6	331	出生后	出生队列研究	儿童行为评估系统;第二版学龄前家长评定量表;执行功能行为评定量表	孕前BMI;成人ADHD自我报告量表	母体因素：孕期母亲体质量增加(孕前BMI ≥ 35 kg/m²)
Morales等^[36](2015)	西班牙	正常儿童	4~5(4.8)	1 650	出生前	前瞻性出生队列研究	DSM-IV;儿童调查问卷(老师填写)	妊娠13周时25-羟基维生素D3的血浆浓度;调查问卷(母亲妊娠晚期填写)	母体因素：维生素D低
Shih等^[37](2020)	中国	正常儿童	8	374/16 002	出生前	前瞻性纵向队列研究	医生和专家评估(未明确描述)	台湾出生登记;结构化问卷调查;台湾空气质量监测网站;儿童6个月时与家长面对面访谈	环境因素：NO暴露
Mikkelsen等^[38](2017)	芬兰	正常儿童	5~16	295 687	出生后	队列研究	ICD-10	Apgar评分;脐动脉脐带pH值;芬兰全国登记	围产期意外：出生窒息
Rodriguez等^[39](2008)	瑞典丹麦芬兰	学龄前儿童	7~8 (SE、FI) 10~12 (DK)	12 556	出生前	前瞻性妊娠队列研究	瑞典和丹麦：优势与困难问卷;芬兰：Rutter量表	医疗记录和问卷;母亲自我报告问卷	母体因素：母亲肥胖或超重
Nomura等^[40](2012 )	美国	学龄前儿童	3~4	212	出生后	队列研究	ADHD评定量表-IV;情感障碍和精神分裂症时间表;初级智力量表第三版;儿童气质评估修订版;儿童行为评估系统-2;家长和教师评定量表;发育神经心理学评估	社会经济声望指数;访谈	母体因素：妊娠期糖尿病环境因素：低社会经济地位
Huizink等^[41](2007)	芬兰	宫内焦虑暴露双胞胎儿童	14	232/572	出生前	前瞻性队列对照研究	青少年酗酒遗传学半结构化评估;DSM-III-R	暴露于1986年4月切尔诺贝利灾难(压力源)	母体因素：孕期焦虑暴露
Hack等^[42](2009)	美国	极低出生体质量儿童	8	219/176	出生后	队列对照研究	CSI-4(家长填写);DSM-IV	出生记录	围产期意外：极低出生体质量(出生体质量< 1 kg)
Perricone等^[43](2013)	意大利	早产儿	5.2	50/50	出生后	对照研究	教师早期ADHD检测问卷;DSM-IV;Kendall and Wilcox量表;父母ADHD早期检测问卷	问卷调查儿童出生基本信息(家长和儿童)	围产期意外：中度早产(< 36周)
Morrow等^[44](2009)	美国	可卡因暴露儿童	5	208/192	出生前	前瞻性队列对照研究	DSM-IV;儿童计算机诊断访谈计划	产妇访谈;生物标志物检测(母婴尿液和胎粪);巴拉德胎龄评估;血铅水平	母体因素：可卡因暴露

表1

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导致儿童注意力缺陷多动障碍的孕期和围产期危险因素Scoping综述

Risk factors during pregnancy and perinatal period for attention deficit hyperactivity disorder in children: a scoping review

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