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目的:探讨产前环境因素与儿童注意缺陷多动障碍(ADHD)及其症状严重程度的关联。方法:纳入符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)的ADHD儿童1 156例、正常对照儿童289名。使用儿童临床诊断性会谈量表进行ADHD诊断，使用ADHD评定量表评估ADHD核心症状，使用问卷调查收集各产前环境因素分布情况。结果:母亲产前应激可能为儿童ADHD的危险因素(OR=1.22,P<0.01);受孕时父亲饮酒习惯与儿童多动/冲动症状正向关联(β=0.08,P<0.05),母亲产前吸烟与儿童注意缺陷症状、多动/冲动症状和总症状正向关联(β=0.07～0.09,P<0.05)。结论:母亲产前应激可能为儿童ADHD的危险因素，受孕时父亲饮酒习惯、母亲产前吸烟可能与儿童ADHD症状有关。
Abstract：Objective:To investigate the association between prenatal environmental factors and attention deficit hyperactivity disorder(ADHD) and its symptom severity in children.Methods:Based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition(DSM-IV) diagnosis criteria, 1 156 children with ADHD and 289 normal control children were included in this study.ADHD diagnoses were established using the Clinical Diagnostic Interview Scale, core symptoms were assessed with the ADHD Rating Scale, and information on prenatal exposures were collected via self-developed questionnaires.Results:Maternal stress during pregnancy was associated with increased risk factor of ADHD in children(OR=1.22,P<0.01).Among children with ADHD,preconception paternal alcohol consumption was positively associated with hyperactivity/impulsivity symptoms(β=0.08,P<0.05),and maternal smoking during pregnancy was positively associated with total symptoms(β=0.07-0.09,P<0.05).Conclusion:Maternal stress during pregnancy may increase the risk factor of ADHD in children.Both preconception paternal alcohol consumption and maternal smoking during pregnancy may be associated with increased ADHD symptom severity in children.
[1] American Psychiatric Association.Diagnostic and statistical manual of mental disorders:DSM-5TM[M].Washington:American Psychiatric Association,2013.
[2] Schein J,Cloutier M,Gauthier-Loiselle M,et al.Healthcare resource utilization and costs associated with psychiatric comorbidities in pediatric patients with attention-deficit/hyperactivity disorder:a claims-based case-cohort study[J].Child Adolesc Psychiatry Ment Health,2024,18(1):80.doi:10.1186/s13034-024-00770-8.
[3] Thapar A,Cooper M.Attention deficit hyperactivity disorder[J].Lancet,2016,387(10024):1240-1250.
[4] Barker DJ,Osmond C,Golding J,et al.Growth in utero,blood pressure in childhood and adult life,and mortality from cardiovascular disease[J].BMJ,1989,298(6673):564-567.
[5] Lin LZ,Xu SL,Wu QZ,et al.Association of prenatal,early postnatal,or current exposure to secondhand smoke with attention-deficit/hyperactivity disorder symptoms in children[J].JAMA Netw Open,2021,4(5):e2110931.doi:10.1001/jamanetworkopen.2021.10931.
[6] Fang XY,Strodl E,Liu BQ,et al.Association between prenatal exposure to household inhalants exposure and ADHD-like behaviors at around 3 years of age:findings from Shenzhen Longhua Child Cohort Study[J].Environ Res,2019,177:108612.doi:10.1016/j.envres.2019.108612.
[7] Lebeňa A,Faresj? ?,Jones MP,et al.Early environmental predictors for attention-deficit hyperactivity disorder (ADHD),autism spectrum disorder (ASD) and their co-occurrence:the prospective ABIS-Study[J].Sci Rep,2024,14(1):14759.doi:10.1038/s41598-024-65067-4.
[8] Howell MP,Jones CW,Herman CA,et al.Impact of prenatal tobacco smoking on infant telomere length trajectory and ADHD symptoms at 18 months:a longitudinal cohort study[J].BMC Med,2022,20:153.doi:10.1186/s12916-022-02340-1.
[9] He Y,Chen J,Zhu LH,et al.Maternal smoking during pregnancy and ADHD:results from a systematic review and meta-analysis of prospective cohort studies[J].J Atten Disord,2020,24(12):1637-1647.
[10]Eilertsen EM,Gjerde LC,Reichborn-Kjennerud T,et al.Maternal alcohol use during pregnancy and offspring attention-deficit hyperactivity disorder (ADHD):a prospective sibling control study[J].Int J Epidemiol,2017,46(5):1633-1640.
[11]Sundquist J,Sundquist K,Ji J.Autism and attention-deficit/hyperactivity disorder among individuals with a family history of alcohol use disorders[J].eLife,2014,3:e02917.doi:10.7554/eLife.02917.
[12]Kendler KS,Abrahamsson L,Sundquist J,et al.Pattern of risks for psychiatric and substance use disorders in the offspring of parents with alcohol use disorder[J].Am J Psychiatry,2024,181(4):322-329.
[13]Luan M,Zhang X,Fang G,et al.Preconceptional paternal alcohol consumption and the risk of child behavioral problems:a prospective cohort study[J].Sci Rep,2022,12(1):1508.doi:10.1038/s41598-022-05611-2.
[14]Roetner J,Van Doren J,Maschke J,et al.Effects of prenatal alcohol exposition on cognitive outcomes in childhood and youth:a longitudinal analysis based on meconium ethyl glucuronide[J].Eur Arch Psychiatry Clin Neurosci,2024,274(2):343-352.
[15]Manzari N,Matvienko-Sikar K,Baldoni F,et al.Prenatal maternal stress and risk of neurodevelopmental disorders in the offspring:a systematic review and metavanalysis[J].Soc Psychiatry Psychiatr Epidemiol,2019,54(11):1299-1309.
[16]Kacharava T,Nemsadze K,Inasaridze K.Elevated level of testosterone in amniotic fluid during prenatal stress and its association with development of attention-deficit/hyperactivity disorder (ADHD) like symptoms in toddlers[J].Pediatr Endocrinol Diabetes Metab,2023,29(4):248-252.
[17]Jallow J,Hurtig T,Kerkel? M,et al.Prenatal maternal stress,breastfeeding and offspring ADHD symptoms[J].Eur Child Adolesc Psychiatry,2024,33(11):4003-4011.
[18]Borgert M,Melin A,Hollander AC,et al.Prenatal maternal PTSD as a risk factor for offspring ADHD:a register-based Swedish cohort study of 553 766 children and their mothers[JL].Eur Psychiatry,2024,67(1):e22.doi:10.1192/j.eurpsy.2024.21.
[19]杨莉，王玉凤，钱秋谨，等.注意缺陷多动障碍患儿的临床分型初探[J].中华精神科杂志，2001,34(4):15-18.
[20]American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders.(DSM-VI)[M].Washington,DC:American Psy chiatric Association,1994.
[21]龚耀先，蔡太生.中国修订韦氏儿童智力量表手册[M].长沙：湖南地图出版社，1993.
[22]苏林雁，耿耀国，王洪.注意缺陷多动障碍诊断量表父母版的中国城市儿童常模制定及其信度和效度的检验[J].中国实用儿科杂志，2006,21(11):833-836.
[23]Robinson LR,Bitsko RH,O′Masta B,et al.A systematic review and meta-analysis of parental depression,antidepressant usage,antisocial personality disorder,and stress and anxiety as risk factors for attention-deficit/hyperactivity disorder (ADHD) in children[J].Prev Sci,2024,25(Suppl 2):272-290.
[24]Shao S,Wang J,Huang K,et al.Prenatal pregnancy-related anxiety predicts boys′ ADHD symptoms via placental C-reactive protein[J].Psychoneuroendocrinology,2020,120:104797.doi:10.1016/j.psyneuen.2020.104797.
[25]Talge NM,Neal C,Glover V,et al.Antenatal maternal stress and long‐term effects on child neurodevelopment:how and why?[J].J Child Psychol Psychiatry,2007,48(3-4):245-261.
[26]Abel EL.Rat offspring sired by males treated with alcohol[J].Alcohol,1993,10(3):237-242.
[27]Wozniak DF,Cicero TJ,Kettinger L,et al.Paternal alcohol consumption in the rat impairs spatial learning performance in male offspring[J].Psychopharmacology (Berl),1991,105(2):289-302.
[28]Abel EL,Bilitzke P.Paternal alcohol exposure:paradoxical effect in mice and rats[J].Psychopharmacology (Berl),1990,100(2):159-164.
[29]Abel EL,Dintcheff BA.Effects of prenatal alcohol exposure on behavior of aged rats[J].Drug Alcohol Depend,1986,16(4):321-330.
[30]Weinberg NZ.Cognitive and behavioral deficits associated with parental alcohol use[J].J Am Acad Child Adolesc Psychiatry,1997,36(9):1177-1186.
[31]Braun JM,Messerlian C,Hauser R.Fathers matter:why it′s time to consider the impact of paternal environmental exposures on children′s health[J].Curr Epidemiol Rep,2017,4(1):46-55.
[32]Krawetz SA,Kruger A,Lalancette C,et al.A survey of small RNAs in human sperm[J].Hum Reprod,2011,26(12):3401-3412.
[33]Xie T,Mao Y.The causal impact of maternal smoking around birth on offspring ADHD:a two-sample Mendelian randomization study[J].J Affect Disord,2024,351:24-30.doi:10.1016/j.jad.2024.01.196.
[34]Thakur GA,Sengupta SM,Grizenko N,et al.Maternal smoking during pregnancy and ADHD:a comprehensive clinical and neurocognitive characterization[JL].Nicotine Tob Res,2013,15(1):149-157.
[35]Dwyer JB,Mcquown SC,Leslie FM.The dynamic effects of nicotine on the developing brain[J].Pharmacol Ther,2009,122(2):125-139.
[36]Buck JM,Sanders KN,Wageman CR,et al.Developmental nicotine exposure precipitates multigenerational maternal transmission of nicotine preference and ADHD-like behavioral,rhythmometric,neuropharmacological,and epigenetic anomalies in adolescent mice[J].Neuropharmacology,2019,149:66-82.doi:10.1016/j.neuropharm.2019.02.006.
[37]Ott T,Nieder A.Dopamine and cognitive control in prefrontal cortex[J].Trends Cogn Sci,2019,23(3):213-234.
[38]Mueller A,Hong DS,Shepard S,et al.Linking ADHD to the neural circuitry of attention[J].Trends Cogn Sci,2017,21(6):474-488.
[39]Franke RM,Park M,Belluzzi JD,et al.Prenatal nicotine exposure changes natural and drug-induced reinforcement in adolescent male rats[J].Eur J Neurosci,2008,27(11):2952-2961.
[40]Dwyer JB,Cardenas A,Franke RM,et al.Prenatal nicotine sex-dependently alters adolescent dopamine system development[J].Transl Psychiatry,2019,9(1):304.doi:10.1038/s41398-019-0640-1.
[41]Nonkovic N,Marceau K,Mcgeary JE,et al.Maternal smoking during pregnancy is associated with DNA methylation in early adolescence:a sibling comparison design[J].Dev Psychol,2024,60(9):1639-1654.
[42]Behbod B,Sharma M,Baxi R,et al.Family and carer smoking control programmes for reducing children′s exposure to environmental tobacco smoke[J].Cochrane Database Syst Rev,2018,1(1):CD001746.doi:10.1002/14651858.CD001746.pub4.
基本信息:
中图分类号:R749.94
引用信息:
[1]杨子琦,岳鑫鑫,刘璐,等.产前环境因素与儿童注意缺陷多动障碍的关联研究[J].中国心理卫生杂志,2025,39(12):1037-1042.
基金信息:
北京市科技新星计划(20220484061); 国家自然科学基金(82271575); 北京大学临床医学+X青年专项; 中央高校基本科研业务费(PKU2023LCXQ043)
2025-11-14
2025-11-14
2025-11-14