Attention-deficit/hyperactivity disorder in the offspring following prenatal maternal bereavement: a nationwide follow-up study in Denmark

Severe prenatal stress exposure has been found to increase the risk of neuropsychiatric conditions like schizophrenia. We examined the risk of attention-deficit/hyperactivity disorder (ADHD) in the offspring following prenatal maternal bereavement, as a potential source of stress exposure. We conducted a nationwide population-based cohort study including all 1,015,912 singletons born in Denmark from 1987 to 2001. A total of 29,094 children were born to women who lost a close relative during pregnancy or up to 1 year before pregnancy. These children were included in the exposed cohort and other children were in the unexposed cohort. We used Cox regression to estimate hazard ratios for ADHD, defined as the first-time ADHD hospitalization or first-time ADHD medication after 3 years of age. Boys born to mothers who were bereaved by unexpected death of a child or a spouse, had a 72% increased risk of ADHD [hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.09–2.73]. Boys born to mothers who lost a child or a spouse during 0–6 months before pregnancy and during pregnancy had a HR of 1.47 (95% CI 1.00–2.16) and 2.10 (95% CI 1.16–3.80), respectively. Our findings suggest that prenatal maternal exposure to severe stress may increase the risk of ADHD in the offspring.     

Parental psychopathology and offspring attention-deficit/hyperactivity disorder in a nationwide sample

ObjectiveTo study the associations between a wide range of parental psychiatric disorders and offspring attention-deficit/hyperactivity disorder (ADHD).MethodThis study is based on a nested case–control design. The association between parental registered psychiatric diagnoses and offspring ADHD was examined adjusting for socioeconomic and prenatal factors. Data was linked from Finnish nationwide registers. The cases (n = 10,409) were all the children born between years 1991 and 2005 in Finland and diagnosed with ADHD by the end of 2011. Four controls without ADHD (n = 39,124) were matched for every case by sex, age and place of birth. Main outcomes were adjusted odds ratio (aOR) for parental diagnosis of cases vs controls. Analyses were further stratified by sex. Disorders diagnosed before and after birth were analyzed separately.ResultsThe odds ratio for ADHD increased when only mother (aOR 2.2, 95% CI 2.0–2.3), only father (aOR 1.7, 95% CI 1.6–1.8) and both parents (aOR 3.6, 95% CI 3.3–4.0) were diagnosed. Maternal diagnosis showed stronger association than paternal. The weight of association between several parental disorders and offspring ADHD were similar. Maternal psychopathology overall showed stronger associations with girls than boys with ADHD. The diagnoses registered after birth did not show stronger association than the diagnoses registered before. Conclusions: Maternal psychopathology showing stronger association than paternal implies that environmental factors or their interaction with genetic factors partly mediates the risk of parental psychopathology. Similar associations between several maternal psychiatric disorders and offspring ADHD points towards the need for investigating some common mother-related risk factors.     

Maternal Substance Abuse and the Later Risk of Fractures in Offspring: L’abus maternel de substances et le risque ultérieur de fractures chez les enfants

Objective:To assess the association of maternal illicit drug abuse before or during pregnancy with future fractures in offspring.Methods:We performed a longitudinal cohort study of 792,022 infants born in hospitals of Quebec, Canada, between 2006 and 2016, with 5,457,634 person-years of follow-up. The main exposure was maternal substance abuse before or during pregnancy, including cocaine, opioid, cannabis, and other illicit drugs. The main outcome measure was hospitalization for traumatic fracture in offspring up to 12 years of age. We used adjusted Cox regression models to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association of maternal drug abuse with the subsequent risk of fracture in children.Results:The incidence of child fractures was higher for maternal illicit drug abuse than no drug abuse (21.2 vs. 15.4 per 10,000 person-years). Maternal drug abuse before or during pregnancy was associated with 2.35 times the risk of assault-related fractures (95% CI, 1.29 to 4.27) and 2.21 times the risk of transport accident-related fractures (95% CI, 1.34 to 3.66), compared with no drug abuse. Associations were strongest before 6 months of age for assault-related fractures (HR = 2.14; 95% CI, 0.97 to 4.72) and after 6 years for transport-related fractures (HR = 2.86; 95% CI, 1.35 to 6.05). Compared with no drug abuse, associations with assault and transport-related fractures were elevated for all drugs including cocaine, opioids, and cannabis.Conclusions:Maternal illicit drug abuse is associated with future child fractures due to assault and transport accidents.     

Asthma Severity and Control and Their Association With Perinatal Mental Illness

ObjectiveGrowing evidence suggests asthma increases perinatal mental illness risk, but few studies have explored the impact of asthma severity and control. Our objective was to explore the association between asthma severity and control and perinatal mental illness risk and the impact of asthma exacerbations during pregnancy on postpartum mental illness risk.MethodsThis was a population-based retrospective cohort study of all women in Ontario, Canada, from 2005 to 2015 with a singleton live birth who used public drug insurance, excluding women with recent history of mental illness. We constructed modified Poisson regression models to assess the risk of perinatal mental illness, defined as a mood or anxiety, psychotic or substance use disorder, self-harm or other mental illness diagnosed from conception to 365 days postnatally. Models controlled for socio-demographic factors and medical history.ResultsThere were 62,583 women in the cohort (46.7% between 15 − 24 years), of whom 22.7% had asthma (94.3% mild, 5.7% moderate/severe; 86.5% controlled and 13.5% uncontrolled). After adjustment, there was increased risk of perinatal mental illness with mild asthma (adjusted relative risk [RR]: 1.12; 95% confidence interval [CI], 1.09 to 1.16) and moderate/severe asthma (aRR: 1.16; 95% CI, 1.04 to 1.30) compared to no asthma. Controlled asthma (aRR: 1.11; 95% CI, 1.08 to 1.15) and uncontrolled asthma (aRR: 1.19; 95% CI, 1.11 to 1.27) were also associated with increased perinatal mental illness risk compared to no asthma. Women with worsened asthma during pregnancy had the highest risk of postpartum mental illness compared to no change in asthma status (by severity: aRR: 1.57; 95% CI, 1.36 to 1.80; by control: aRR: 1.37; 95% CI, 1.22 to 1.54).ConclusionAsthma is associated with increased risk of perinatal mental illness, particularly in the presence of asthma exacerbations in pregnancy. The results support multidisciplinary collaborative care programmes throughout the perinatal period, especially among women with asthma exacerbations during pregnancy.     

Prenatal tobacco use and the risk of mood disorders in offspring: a systematic review and meta-analysis

Purpose

It is plausible that offspring born to mothers using tobacco during pregnancy may have increased risk of mood disorders (depression and bipolar disorders); however, mixed results have been reported. We conducted a systematic review and meta-analysis to investigate the magnitude and consistency of associations reported between prenatal tobacco use and mood disorders in offspring.

Methods

We systematically searched EMBASE, SCOPUS, PubMed and Psych-INFO for studies on mood disorders and prenatal tobacco use. Methodological quality of studies was assessed with the revised Newcastle–Ottawa Scale. We estimated pooled relative risk (RR) with inverse variance weighted random-effects meta-analysis. We performed leave-one-out analyses, and stratified analyses by a subgroup (depression and bipolar disorder). Potential publication bias was assessed by inspection of the funnel plot and Egger’s test for regression asymmetry. This study protocol was prospectively registered in PROSPERO (CRD42017060037).

Results

Eight cohort and two case–control studies were included in the final meta-analysis. We found an increased pooled relative risk of mood disorders in offspring exposed to maternal prenatal tobacco use RRs 1.43 (95% CI 1.27–1.60) compared to no prenatal tobacco use. Similarly, the pooled relative risks of bipolar and depressive disorders in offspring were 1.44, (95% CI 1.15–1.80) and 1.44, (95% CI 1.21–1.71), respectively. Moreover, the pooled estimated risk of mood disorders was not significantly attenuated in the studies that reported sibling comparison results [RR = 1.21 (95% CI 1.04–1.41)].

Conclusion

Taken together, there was strong evidence for a small (RR < 2) association between prenatal tobacco use and mood disorders in offspring.

     

Associations of sleep duration and quality with incident cardiovascular disease,cancer, and mortality: a prospective cohort study of 407,500 UK biobank participants

ObjectiveFew studies have investigated the associations of sleep duration and sleep quality with incident cardiovascular diseases (CVDs), cancer, and mortality in the same large population. This study aimed at estimating the independent risk factors of long or short sleep durations and several typical characteristics of poor sleep quality for incident CVDs, cancer, and mortality.MethodsIn this prospective cohort study, 407 500 individuals were enrolled. Cox proportional hazards models were used to calculate the adjusted hazard ratios and 95% confidence intervals (HR, 95%CI) of associations of sleep duration and quality with incident CVDs, cancer, and mortality.ResultsCompared with the sleep duration of 7 h, sleep duration of ≤5 h and ≥9 h were both associated with higher risk of all-cause mortality (HR = 1.25, 95% CI: 1.16–1.34 and HR = 1.30, 95% CI: 1.22–1.38, respectively), CVD mortality (HR = 1.27, 95% CI: 1.09–1.49 and HR = 1.32, 95% CI: 1.16–1.50, respectively), and CVD incidence (HR = 1.23, 95% CI: 1.16–1.31 and HR = 1.08, 95% CI: 1.02–1.15, respectively). Additionally, long sleep duration (≥9 h) was associated with a higher risk of cancer mortality (HR = 1.19, 95% CI: 1.10–1.30) and cancer incidence (HR = 1.08, 95% CI: 1.04–1.12). Moreover, CVD incidence was significantly associated with snoring, insomnia and narcolepsy, increasing the risk by 7%, 26%, and 20%, respectively.ConclusionLong sleep durations may substantially increase the risk of mortality and morbidity. Snoring, insomnia, and narcolepsy were independent risk factors for incident CVD.     

Infections of the central nervous system as a risk factor for mental disorders and cognitive impairment: A nationwide register-based study

BackgroundCNS infections have been suggested as risk factors for cognitive decline and mental disorders; however, large-scale studies have been lacking regarding types and agents of CNS infections.MethodsWe utilized the unique personal registration number to create a cohort of 1,709,867 individuals born 1977–2010. CNS infection was exposure and data were analysed with 1) cox regression analyses estimating hazard ratios (HR) for developing mental disorders and 2) binomial regression estimating relative risk (RR) for completion of 9th grade including average grade score in a sub-cohort born 1988–1998.ResultsCNS infection increased the risk for developing mental disorders with a HR of 1.34 (95% CI 1.27–1.42). The highest risk observed was within the first 6 months after the CNS infection with a HR of 26.98 (95% CI 21.19–34.35). Viral CNS infections (HR 1.47, 95% CI 1.35–1.61) conferred a higher risk (p < 0.001) than bacterial (HR 1.24, 95% CI 1.15–1.35). Encephalitis (HR 1.64, 95% CI 1.41–1.90) conferred a higher risk (p < 0.001) than meningitis (HR 1.26, 95% CI 1.18–1.35). The risk was highest for organic mental disorders (HR 6.50, 95% CI 5.11–8.28) and disorders of intellectual development (HR 3.56, 95% CI 2.94–4.31), with a HR of 19.19 (95% CI 7.46–49.35) for profound disorder of intellectual development (IQ < 20). Furthermore, CNS infection decreased the RR of completing 9th grade of mandatory schooling (RR 0.89, 95% CI 0.88–0.91) and lowered average grade score for completers (p < 0.001).ConclusionsCNS infections increased the risk for mental disorders and decreased the likelihood of completing 9th grade, indicating long-term consequences of CNS infections.     

Family history of stroke and death or vascular events within one year after ischemic stroke

ABSTRACT

Background and aims: The association between family history of stroke and clinical outcomes after ischemic stroke remains unclear.

Methods: A total of 3878 acute ischemic stroke patients from CATIS were included. The participants with ischemic stroke were divided into groups according to types of family history of stroke, stroke onset age and stroke subtypes. The primary outcome was a composite outcome of death and vascular events within 1 year after stroke. Multivariable Cox proportional hazard models were used to analyze the association between family history of stroke and other variables and clinical outcomes.

Results: Among 3878 ischemic stroke patients, 708 (18.26%) had a history of stroke in their first-degree relatives and 399 experienced a composite outcome (172 patients died and 227 experienced vascular events) within 1 year after stroke. Overall family history was not associated with the primary outcome (HR, 1.08; 95% CI, 0.37–3.19). However, the patients with maternal stroke history (HR, 1.87; 95% CI, 1.31–2.97), stroke onset age<55 years with family history (HR, 2.02; 95% CI, 1.08–3.80) and thrombotic stroke in the patients with family history (HR, 1.46; 95% CI, 1.00–2.12) were associated with primary outcome, death and vascular events, respectively.

Conclusion: This study suggests that maternal stroke history, age<55 years at stroke onset and thrombotic stroke in the patients with a family history are associated with poor outcomes after stroke. Further studies from other samples are needed to replicate our findings due to a reason for excluding some severe stroke patients in this study.     

Obstetric Complications as Risk Factors for Schizophrenia Spectrum Psychoses in Offspring of Mothers With Psychotic Disorder

Background:

Obstetric complications have predicted future development of schizophrenia in previous studies, but they are also more common in mothers with schizophrenia. The aims of this study were to compare the occurrence of obstetric complications in children of mothers with schizophrenia spectrum psychoses and control children, and to investigate whether obstetric complications predicted children’s psychiatric morbidity.

Method:

The Helsinki High-Risk (HR) Study monitors females born between 1916 and 1948 and treated for schizophrenia spectrum disorders in Helsinki psychiatric hospitals, their offspring born between 1941 and 1977, and controls. We examined information on obstetric complications and neonatal health of 271 HR and 242 control offspring. We compared the frequency of obstetric complications and neonatal health problems in the HR group vs controls and in HR children who later developed psychotic disorders vs healthy HR children. A Cox regression model was used to assess whether problems in pregnancy or delivery predicted psychiatric morbidity within the HR group.

Results:

Few differences between HR and control offspring were found in obstetric complications. Within the HR group, infections (hazard rate ratio [HRR] 3.73, 95% CI 1.27–11.01), hypertension during pregnancy (HRR 4.10, 95% CI 1.15–14.58), and placental abnormalities (HRR 4.09, 95% CI 1.59–10.49) were associated with elevated risk of schizophrenia spectrum psychoses.

Conclusions:

Common medical problems during pregnancy were associated with increased risk of schizophrenia spectrum psychoses in offspring of mothers with schizophrenia spectrum psychoses. These results underline the role of the prenatal period in the development of schizophrenia and the importance of careful monitoring of pregnancies of mothers with psychotic disorder.Key words: schizophrenia, High-Risk Study, obstetric complications, risk factors, prenatal infections     

Exposure to maternal depressive symptoms in childhood and suicide-related thoughts and attempts in Canadian youth: test of effect-modifying factors

Purpose

To (1) determine the association between exposure to maternal depressive symptoms in childhood and offspring suicide-related thoughts (SRT) and attempts (SA) in youth and young adults and (2) identify effect measure modifiers (offspring sex, family structure, maternal perceived social support, and social cohesion) of the association in 1.

Method

A cohort was constructed by linking all cycles from the National Longitudinal Survey of Children and Youth, a Canadian nationally representative survey, from 1994 to 2009 in 16,903 subjects 0 to 25 years. Exposure to maternal-reported depressive symptoms was measured when offspring were between 0 and 10 years. Offspring self-reported incident and recurrent SRT and SA were measured between 11 and 25 years. Time-to-event models under a counting process framework were used to estimate adjusted hazard ratios (HR) and relative rates (RR) and 95% confidence intervals (CI). Effect measure modifiers were examined across adjusted stratum-specific estimates.

Results

In offspring exposed to maternal depressive symptoms, the adjusted rates of incident SRT and SA (HR: 1.67, 95% CI 1.37, 2.08; HR: 1.93, 95% CI 1.43, 2.50) and of recurrent SRT and SA (RR: 1.61, 95% CI 1.33, 1.96; RR: 1.87, 95% CI 1.40, 2.36) were significantly elevated compared to non-exposed offspring. The stratum-specific rates of incident and recurrent SRT and SA were significantly elevated in females but not in males.

Conclusions

Girls exposed to maternal depressive symptoms in childhood are a target group for childhood suicide preventive strategies. Family-based preventions, and strategies to identify and effectively treat maternal depressive episodes could be beneficial for suicide prevention in offspring.

     

Overweight in family members of probands with ADHD

The widely reported association between ADHD and overweight may be attributable to genetic and environmental factors also present in unaffected family members. Therefore, the purpose of this study was to examine the association between ADHD and overweight within families. A cohort was used of families with at least one member with ADHD, recruited as part of the Dutch node of the International Multicenter ADHD Genetics (IMAGE) study, with assessments taking place between 2003 and 2006, 2009 and 2012, and 2013 and 2015. The three assessment waves yielded N = 1828 youth assessments and N = 998 parent assessments from N = 447 unique families. Overweight was defined as a body mass index (BMI) ≥ 85th percentile for youth of the same age and sex; overweight in adults as a BMI ≥ 25. Effects of age, gender, and medication use (psychostimulants, antipsychotics, and melatonin) were taken into account. Generalized estimation equations were used to correct for within-family and within-subject correlations. There was no difference in risk between ADHD-affected youth and their unaffected siblings (OR 0.92, 95% CI 0.78–1.09). However, compared to population prevalence data, all ADHD family members alike were at increased risk for being overweight: ADHD-affected youth (OR 1.33, 95% CI 1.13–1.59), unaffected siblings (OR 1.73, 95% CI 1.45–2.08), mothers (OR 1.74, 95% CI 1.40–2.17) and fathers (OR 1.78, 95% CI 1.46–2.15). Parental overweight—but not parental ADHD—was predictive of offspring overweight (mothers OR 1.40; 95% CI 1.14–1.73, fathers OR 1.83; 95% CI 1.41–2.36). Being overweight runs in ADHD families, yet is not specifically linked to ADHD within families. Shared unhealthy lifestyle factors (including nutrition, sleep, exercise, stress) as well as genetic factors shared by family members likely explain the findings.

     

Maternal flu or fever,medications use in the first trimester and the risk for neural tube defects: a hospital-based case–control study in China

Purpose

This study aims to evaluate the effects of maternal flu or fever, and medications (antibiotics and antipyretics) use in the first trimester on neural tube defects (NTDs) risk in offspring.

Methods

Data came from a hospital-based case–control study conducted between 2006 and 2008 in Shandong/Shanxi provinces including 459 mothers with NTD-affected births and 459 mothers without NTD-affected births. Logistic regression models were used to evaluate the effects of maternal flu, fever, and medications use on NTD risk. The effects were evaluated by adjusted odds ratio (OR) and 95 % confidence intervals (CIs) with SAS9.1.3.software.

Results

NTDs risks were significantly associated with maternal flu or fever (OR?=?2.63, 95 % CI?=?1.64–4.23) and antipyretics use (OR?=?3.38, 95 % CI?=?1.68–6.79), but not with antibiotics use (OR?=?1.82, 95 % CI?=?0.85–3.93). The risk effect of antipyretics use on anencephaly (OR?=?7.81, 95 % CI?=?1.96–31.13) was markedly higher than on spina bifida (OR?=?3.02, 95 % CI?=?1.08–8.42). Maternal flu or fever together with antipyretics use showed a higher OR for total NTDs (3.27 vs.1.87), anencephaly (7.38 vs.2.08), and spina bifida (2.97 vs.2.07) than maternal flu or fever with no antipyretics use.

Conclusions

Maternal flu or fever and antipyretics use in the first trimester were risk for NTDs. Maternal flu or fever together with antipyretics use increased NTD risk than only maternal flu or fever.     

Maternal androgens and autism spectrum disorder in the MARBLES prospective cohort study

BackgroundMaternal hormonal risk factors for autism spectrum disorder (ASD) in offspring could intersect genetic and environmental risk factors.ObjectivesThis analysis explored ASD risk in association with maternal testosterone, androstenedione, and dehydroepiandrosterone (DHEA) measured in first, second, and third trimesters of pregnancy.MethodsMARBLES is a prospective pregnancy cohort study based at the MIND Institute in Northern California that enrolls mothers who have at least one child previously diagnosed with ASD and are expecting, or planning to have another child. At 36 months the younger sibling is clinically classified as having ASD, or as non-typically developing (Non-TD), or typically developing (TD). Maternal androgens during pregnancy were measured in serum samples from 196 mothers. Multivariable logistic regression models estimated risk of ASD and Non-TD in offspring compared to TD, in relation to the log-transformed maternal androgen concentrations, at each trimester.ResultsNon-significant associations were observed, and borderline significant associations were only observed in some stratified unadjusted models. Second trimester maternal testosterone was non-significantly associated with ASD in female offspring, although not after adjustment, aRR 1.54 (95% CI 0.71, 3.33), and second trimester maternal DHEA was non-significantly associated with non-TD in male offspring, again not after adjustment, aRR 0.50 (95% CI 0.21, 1.21). Secondary analysis suggested that third trimester androgen concentrations in mothers with male offspring had significant or near significant associations with their child’s Social Responsiveness Scale score.ConclusionNo significant associations were found between maternal androgen concentrations and risk of ASD or Non-TD in the child.     

Preeclampsia and the longitudinal risk of hospitalization for depression at 28 years

Purpose

The association between pregnancy characteristics and risk of depression in women is poorly understood. We investigated the relationship between preeclampsia and risk of hospitalization for depression over three decades.

Methods

We carried out a longitudinal cohort study of 1,210,963 women who delivered an infant in any hospital in Quebec, Canada, between 1989 and 2016. The exposure was preeclampsia at the first or in subsequent pregnancies, including preeclampsia onset time (early < 34 weeks vs. late ≥ 34 weeks of gestation) and severity (mild, severe, superimposed). The outcome was hospitalization for depression any time after pregnancy. We used Cox proportional hazards regression models adjusted for maternal characteristics to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of preeclampsia with depression hospitalization.

Results

Women with preeclampsia had a higher incidence of hospitalization for depression compared with no preeclampsia (1.43 vs. 1.14 per 1000 person-years). Preeclampsia was associated with 1.16 times the risk of depression hospitalization after 28 years of follow-up (95% CI 1.09–1.23). Associations were present for mild (HR 1.15, 95% CI 1.07–1.24), severe (HR 1.16, 95% CI 1.04–1.29) and late onset preeclampsia (HR 1.17, 95% CI 1.10–1.25). Risks were more pronounced after the first year postpartum.

Conclusion

Preeclampsia appears to be associated with the risk of depression hospitalization several decades after pregnancy. Clinicians who care for women with mental health disorders should be aware that a history of preeclampsia increases the risk of severe depression.

     

Perinatal, maternal, and fetal characteristics of children diagnosed with attention-deficit-hyperactivity disorder: results from a population-based study utilizing the Swedish Medical Birth Register

Aim The aim of this study was to evaluate the impact of pre‐ and perinatal factors on the risk of developing attention‐deficit–hyperactivity disorder (ADHD). Method We investigated the medical history of 237 children (206 male; 31 female) from Malmö, Sweden born between 1986 and 1996 and in whom a diagnosis of ADHD (Diagnostic and Statistical Manual of Mental Disorders‐IIIR or IV) was subsequently made at the Department of Child and Adolescent Psychiatry, Lund University, and a reference group of 31 775 typically developing children from Malmö using data from the Swedish Medical Birth Register. Results The results of multiple logistic regression analysis revealed that ADHD was significantly associated with a young maternal age (odds ratio [OR] for 5y increase 0.87; 95% confidence interval [CI] 0.76–0.99), maternal smoking (OR 1.35; 95% CI 1.14–1.60), maternal birthplace in Sweden (OR 2.04; 95% CI 1.45–2.94), and preterm birth <32 weeks (OR 3.05; 95% CI 1.39–6.71), and a male predominance (OR 6.38; 95% CI 4.37–9.32). Apgar scores at 5 minutes below 7 were significantly associated with ADHD in the univariable analysis (OR 2.60; 95% CI 1.15–5.90). The population‐attributable fraction of ADHD caused by the perinatal factors studied was estimated to be 2.8%. Interpretation The results indicate that the studied factors constitute weak risk factors for developing ADHD.     

Asthma and early smoking associated with high risk of panic disorder in adolescents and young adults

Purpose

Studies have reported a strong link between asthma and panic disorder. We conducted a 17-year community-based large cohort study to examine the relationship between asthma, early smoking initiation, and panic disorder during adolescence and early adulthood.

Methods

A total of 162,766 participants aged 11–16 years were categorized into asthma and nonasthma groups at baseline and compared within the observation period. Covariates during late childhood or adolescence included parental education, cigarette smoking by family members of participants, and participant’s gender, age, alcohol consumption, smoking, and exercise habits. Data for urbanicity, prednisone use, allergic comorbidity, and Charlson comorbidity index were acquired from the National Health Insurance Research Database. The Cox proportional-hazards model was used to evaluate the association between asthma and panic disorder.

Results

Our findings revealed that asthma increased the risk of panic disorder after adjustment for key confounders in the Cox proportional hazard regression model (adjusted HR: 1.70, 95% CI 1.28–2.26). Hospitalizations or visits to the emergency department for asthma exhibited a dose–response effect on the panic disorder (adjusted HR: 2.07, 95% CI 1.30–3.29). Patients with asthma with onset before 20 years of age who smoked during late childhood or adolescence had the greatest risk for panic disorder (adjusted HR: 4.95, 95% CI 1.23–19.90).

Conclusions

Patients newly diagnosed with asthma had a 1.7-times higher risk of developing panic disorder. Smoking during late childhood or adolescence increased the risk for developing the panic disorder in patients with asthma.

     

Higher risk of developing major depression and bipolar disorder in later life among adolescents with asthma: A nationwide prospective study

ObjectivePrevious studies have suggested an immunological dysfunction in mood disorders, but rarely have investigated the temporal association between allergic diseases and mood disorders. Using the Taiwan National Health Insurance Research Database, we attempted to investigate the association between asthma in early adolescence and the risk of unipolar depression and bipolar disorder in later life.MethodsIn all, 1453 adolescents with asthma aged between 10 and 15 years and 5812 age-/gender-matched controls were selected in 1998–2000. Subjects with unipolar depression and bipolar disorder that occurred up to the end of follow-up (December 31 2010) were identified.ResultsAdolescents with asthma had a higher incidence of major depression (2.8% vs. 1.1%, p < 0.001), any depressive disorder (6.1% vs. 2.6%, p < 0.001), and bipolar disorder (1.0% vs. 0.3%, p < 0.001) than the control group. Cox regression analysis showed that asthma in early adolescence was associated with an increased risk of developing major depression (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.14–2.89), any depressive disorder (HR: 1.74, 95% CI: 1.27–2.37), and bipolar disorder (HR: 2.27, 95% CI: 1.01–5.07), after adjusting for demographic data and comorbid allergic diseases.DiscussionAdolescents with asthma had an elevated risk of developing mood disorders in later life. Further studies would be required to investigate the underlying mechanisms for this comorbid association and elucidate whether prompt intervention for asthma would decrease the risk of developing mood disorders.     

Underweight predicts poststroke cardiovascular events in patients without atrial fibrillation

Background and purposeThe purpose of this study was to determine whether underweight is associated with poststroke cardiovascular events and whether such association is different according to the presence of atrial fibrillation (AF).MethodsPatients with acute stroke or transient ischemic attack who were prospectively registered in a multicenter stroke database from April 2008 to July 2020 were analyzed, excluding those aged 75 or older and those who were overweight. We prospectively captured major adverse cardiovascular events (MACE) within one year after stroke. Cox-proportional hazard regression analysis was conducted for each subgroup with or without AF after adjusting for predetermined vascular risk factors and potential confounders.ResultsAmong 30,912 patients, 1494 (4.8%) cases were underweight and 29,418 (95.2%) cases were normal weight. The cumulative event rate of 1-year MACE was higher in the underweight group (9.0%) than in the normal weight group (5.6%). In Cox-proportional regression, underweight was associated with significantly higher MACE (adjusted hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.26–2.09) and recurrent stroke (adjusted HR: 1.42, 95% CI: 1.02–1.98) in all study patients. In patients with AF, the risk of MACE for the underweight group was not significantly increased. In contrast, in patients without AF, the underweight group had a consistently higher risk of MACE (adjusted HR: 1.66, 95% CI: 1.25–2.22) and recurrent stroke (adjusted HR: 1.50, 95% CI: 1.05–2.14).ConclusionsUnderweight increased the risk of MACE and recurrent stroke within one year after acute stroke, especially in stroke without AF.     

The relationship between dietary fibre and stroke: A meta-analysis

ObjectiveAn analysis was conducted to explore the relationship between dietary fibre intake and stroke risk.MethodsPubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and WanFang and Weipu databases were systematically searched to obtain peer-reviewed literature on the relationship between dietary fibre and stroke risk. The search time was as of 1 April 2023. Newcastle–Ottawa Scale (NOS) was used to evaluate the quality of the included studies. The pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated using Stata 16.0. The Q test and I² statistics were used to evaluate the heterogeneity and sensitivity analysis to explore potential bias. Meta-regression analysis was conducted to explore the relationship between total dietary intake quality and stroke risk.ResultsSixteen high-quality studies, involving 855,671 subjects, met the inclusion criteria and were involved in the final meta-analysis. The results showed that higher total dietary fibre (HR: 0.81; 95% CI: 0.75–0.88), fruit fibre (HR: 0.88; 95% CI: 0.82–0.93), vegetable fibre (HR: 0.85; 95% CI: 0.81–0.89), soluble fibre (HR: 0.82; 95% CI: 0.72–0.93) and insoluble fibre (HR: 0.77; 95% CI: 0.66–0.89) had a positive effect on reducing the risk of stroke. However, cereal fibre (HR: 0.90; 95% CI: 0.81–1.00) was not statistically significant in reducing the risk of stroke. For different stroke types, higher total dietary fibre was associated with ischemic stroke (HR: 0.83; 95% CI: 0.79–0.88) and had a similar positive effect but was not found in haemorrhagic stroke (HR: 0.91; 95% CI: 0.80–1.03). Stroke risk decreased with increased total dietary fibre intake (β=–0.006189, P=0.001). No potential bias from the individual study was found from sensitivity analysis.ConclusionIncreasing dietary fibre intake had a positive effect on reducing the risk of stroke. Different dietary fibres have various effects on stroke.