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Maternal Thyroid Function in Early Pregnancy and Child Attention-Deficit Hyperactivity Disorder: An
Deborah Levie1,2,3,4,5,6, Tim I M Korevaar1,2, Tessa A Mulder1,2,3
1The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Insights
This study found no clear link between maternal thyroid hormone levels during pregnancy and attention-deficit hyperactivity disorder (ADHD) in children. Further research is needed to fully understand the complex relationship between maternal thyroid function and child neurodevelopment.
Area of Science:
- Neurodevelopmental disorders
- Endocrinology
- Prenatal health
Background:
- Maternal thyroid hormones are crucial for fetal brain development.
- Both insufficient and excessive maternal thyroid hormones may negatively impact neurodevelopment.
- The specific impact on child behavioral problems, such as attention-deficit hyperactivity disorder (ADHD), requires further investigation.
Purpose of the Study:
- To investigate the association between maternal thyroid function (thyrotropin [TSH] and free thyroxine [fT4]) in early pregnancy and the risk of ADHD in offspring.
- To explore potential effect modification by gestational age and child sex on this association.
Main Methods:
- Analysis of data from 7669 mother-child pairs across three prospective birth cohorts (INMA, Generation R, ALSPAC).
- Maternal TSH and fT4 levels were measured in the first 18 weeks of gestation.
- Child ADHD diagnosis was assessed using DSM-IV criteria based on parent/teacher reports between ages 4.5 and 7.6 years.
Main Results:
- Overall, 3% of children were diagnosed with ADHD.
- Neither continuous maternal TSH nor fT4 levels were significantly associated with an increased risk of ADHD or high ADHD symptom scores.
- A potential association between higher first-trimester fT4 and ADHD symptoms was observed but was not consistent across gestational age and not significant overall.
Conclusions:
- The study found no conclusive evidence linking maternal thyroid function during early pregnancy to the development of ADHD in children.
- No significant effect modification by child sex was detected.
- The findings suggest that maternal thyroid hormone levels within the studied range may not be a primary determinant of childhood ADHD.
Abstract:
Background: Thyroid hormone is essential for optimal fetal brain development. Evidence suggests that both low and high maternal thyroid hormone availability may have adverse effects on child neurodevelopmental outcomes, but the effect on behavioral problems remains unclear. We studied the association of maternal thyrotropin (TSH) and free thyroxine (fT4) concentrations during the first 18 weeks of pregnancy with child attention-deficit hyperactivity disorder (ADHD). Methods: A total of 7669 mother-child pairs with data on maternal thyroid function and child ADHD were selected from three prospective population-based birth cohorts: INfancia y Medio Ambiente (INMA; N = 1073, Spain), Generation R (N = 3812, The Netherlands), and Avon Longitudinal Study of Parents and Children (ALSPAC; N = 2784, United Kingdom). Exclusion criteria were multiple pregnancy, fertility treatment, usage of medication affecting the thyroid, and pre-existing thyroid disease. We used logistic regression models to study the association of maternal thyroid function with the primary outcome, ADHD, assessed via the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria by parents and/or teachers at a median child age of 4.5 to 7.6 years, and with the secondary outcome, an ADHD symptom score above the 90th percentile. Effect modification by gestational age and sex was tested with interaction terms and stratified analyses. Results: Overall, 233 (3%) children met the criteria for ADHD. When analyzed continuously, neither fT4 nor TSH was associated with a higher risk of ADHD (odds ratio [OR] 1.1, 95% confidence interval [CI 1.0-1.3], p = 0.060 and OR 0.9 [CI 0.9-1.1], p = 0.385, respectively) or with high symptom scores. When investigating effect modification by gestational age, a higher fT4 was associated with symptoms above the 90th percentile but only in the first trimester (for fT4 per 1 SD: OR 1.2 [CI 1.0-1.4], p = 0.027). However, these differential effects by gestational age were not consistent. No significant effect modification by sex was observed. Conclusions: We found no clear evidence of an association between maternal thyroid function and child ADHD.
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