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Published on: November 20, 2015
Perinatal adversities in tuberous sclerosis complex: Determinants and neurodevelopmental outcomes
Alexa X D Zhang1, Holan Liang2,3, Fiona S McEwen2,4,5
1Institute of Child Health, University College London, London, UK.
Insights
Perinatal adversity is higher in familial tuberous sclerosis complex (TSC), especially with maternal TSC. However, this adversity did not significantly impact neurodevelopmental outcomes in children with TSC.
Area of Science:
- Genetics and Neurology
- Developmental Pediatrics
Background:
- Tuberous sclerosis complex (TSC) is a genetic disorder with variable clinical manifestations.
- Perinatal factors may influence neurodevelopmental outcomes in TSC, but their association requires further investigation.
Purpose of the Study:
- To investigate the relationship between perinatal adversities and neurodevelopmental outcomes in children with TSC.
- To compare perinatal adversity levels in children with TSC and their unaffected siblings.
Main Methods:
- Prospective, longitudinal UK study (Tuberous Sclerosis 2000) involving 125 children with TSC.
- Retrospective collection of perinatal histories using the Obstetric Enquiry Schedule and Gillberg Optimality Scale.
- Neurodevelopmental outcomes assessed included intellectual ability, autism spectrum disorder, and attention-deficit/hyperactivity disorder.
Main Results:
- Children with familial TSC experienced significantly greater perinatal adversity compared to unaffected siblings.
- Maternal TSC was associated with higher levels of perinatal adversity, unlike paternal TSC.
- No significant association was found between perinatal adversities and neurodevelopmental outcomes after controlling for confounders.
Conclusions:
- Maternal TSC is a marker for increased perinatal risk.
- Increased vigilance is recommended for pregnancies complicated by maternal or fetal TSC.
- Further research is needed to understand the mechanisms behind increased perinatal adversity in TSC.
Aim:
To examine the association between perinatal adversities and neurodevelopmental outcome in tuberous sclerosis complex (TSC).
Method:
The Tuberous Sclerosis 2000 study is a prospective, longitudinal UK study of TSC. In phase 1, mutation type, TSC family history, tuber characteristics, presence of cardiac rhabdomyomas, seizure characteristics, and intellectual ability were assessed in 125 children affected with TSC (64 females, 61 males; median age 39mo, range 4-254). In phase 2, 88 participants (49 females, 39 males; median age 148mo, range 93-323) were assessed for neurodevelopmental outcomes including intellectual ability, autism spectrum disorder, and attention-deficit/hyperactivity disorder. Perinatal histories of 88 participants with TSC and 80 unaffected siblings were collected retrospectively using the Obstetric Enquiry Schedule and coded with a modified Gillberg Optimality Scale to measure levels of perinatal adversity. Data were analysed using Mann-Whitney U tests, Spearman's rank correlation, and linear regression with robust standard errors.
Results:
Children with familial TSC experienced significantly greater perinatal adversity than unaffected siblings. Perinatal adversity was higher in children with TSC-affected mothers than those with unaffected mothers. There was no significant association between perinatal adversities and neurodevelopmental outcomes after controlling for confounders.
Interpretation:
Maternal TSC is a significant marker of elevated perinatal risk in addition to risks incurred by fetal genotype. Pregnancies complicated by maternal or fetal TSC require higher vigilance, and mechanisms underlying increased perinatal adversity require further research.
What This Paper Adds:
Higher perinatal adversity is associated with familial tuberous sclerosis complex (TSC). Maternal TSC was associated with higher frequencies of several perinatal risk markers. Paternal TSC was not associated with higher levels of perinatal adversity. Perinatal adversity levels in TSC1 and TSC2 subgroups did not differ significantly. Perinatal adversities were not associated with neurodevelopmental outcomes.
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