孕前母亲注意缺陷多动障碍与不良产科及围产结局：加拿大安大略省基于人群的队列研究
该研究纳入2013至2023年加拿大安大略省所有住院分娩共1,051,033例，其中22,995例（2.2%）孕前诊断注意缺陷多动障碍（ADHD）。孕前ADHD与严重孕产妇发病率（aRR 1.31，95%CI 1.21-1.42）和严重新生儿发病率（aRR 1.25，95%CI 1.21-1.29）升高相关，子痫前期、早产和小于胎龄儿风险亦升高，但妊娠期糖尿病、死产和新生儿死亡风险未见升高。
要点
- 孕前ADHD与严重孕产妇发病率升高相关（aRR 1.31，95%CI 1.21-1.42）。
- 孕前ADHD与严重新生儿发病率升高相关（aRR 1.25，95%CI 1.21-1.29）。
- 子痫前期、早产<37周和小于胎龄儿风险升高，妊娠期糖尿病、死产和新生儿死亡无显著升高。
核心结论
- 孕前诊断母亲ADHD与部分不良产科及围产结局风险升高相关。
- 此类患者可能从强化支持和旨在优化妊娠结局的照护计划中获益。
研究设计与样本
- 基于人群的队列研究，纳入2013至2023年加拿大安大略省所有住院分娩共1,051,033例。
- 比较孕前有ADHD与无ADHD者，采用改良泊松回归计算相对风险（RR）。
主要发现
- 22,995例（2.2%）孕前诊断ADHD。
- 严重孕产妇发病率在ADHD组为2.8%（640例），无ADHD组为2.3%（23,578例），aRR 1.31（95%CI 1.21-1.42）。
- 严重新生儿发病率分别为15.7%和12.5%，aRR 1.25（95%CI 1.21-1.29）。
- 子痫前期aRR 1.28（95%CI 1.18-1.38），早产aRR 1.41（95%CI 1.35-1.47），小于胎龄儿aRR 1.21（95%CI 1.15-1.26）。
- 妊娠期糖尿病aRR 0.98（95%CI 0.93-1.03），死产aRR 0.81（95%CI 0.69-0.96），新生儿死亡aRR 1.09（95%CI 0.83-1.43）。
关键数值与推荐
- 主要结局为严重孕产妇发病率（SMM）和严重新生儿发病率（SNM）复合指标。
- 次要结局包括妊娠期高血压疾病、妊娠期糖尿病、死产、早产<37周、小于胎龄儿和新生儿死亡。
- 剔除妊娠期填写精神兴奋剂处方者后，结果基本不变。
临床怎么用
- 对孕前ADHD孕妇可考虑加强支持与个体化照护计划以优化妊娠结局。
- 孕期关注子痫前期、早产和小于胎龄儿的筛查与监测。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: A growing number of young women are diagnosed with attention-deficit/hyperactivity disorder (ADHD), yet, little is known about their pregnancy outcomes. OBJECTIVE: To examine the association between a preconception diagnosis of maternal attention/deficit-hyperactivity disorder (ADHD) and adverse obstetrical and perinatal outcomes. STUDY DESIGN: This population-based cohort study comprised all hospital births in Ontario, Canada, 2013 to 2023. Individuals with and without preconception ADHD were compared. Modified Poisson regression generated relative risks (RR) for the outcomes of severe maternal morbidity (SMM) and severe neonatal morbidity (SNM) composite indicators. Secondary outcomes included hypertensive disorders of pregnancy, gestational diabetes mellitus (GDM), stillbirth, preterm birth < 37 weeks, small for gestational age birthweight (SGA), and neonatal mortality. RESULTS: Among 1,051,033 obstetrical deliveries, 22,995 (2.2%) had a diagnosis of ADHD before conception. SMM occurred among 640 individuals with ADHD (2.8%) vs 23,578 (2.3%) without ADHD (aRR: 1.31, 95% CI, 1.21-1.42). SNM occurred at respective rates of 15.7% and 12.5% (aRR: 1.25, 95% CI, 1.21-1.29). Maternal ADHD was also associated with elevated aRRs for preeclampsia (1.28, 95% CI, 1.18-1.38), preterm birth (1.41, 95% CI, 1.35-1.47), and SGA (1.21, 95% CI, 1.15-1.26), but not GDM (0.98, 95% CI, 0.93-1.03), stillbirth (0.81, 95% CI, 0.69-0.96), or neonatal mortality (1.09, 95% CI, 0.83-1.43). After removing individuals who filled a psychostimulant prescription during pregnancy, the findings were largely unchanged. CONCLUSIONS: A preconception diagnosis of maternal ADHD is associated with a higher risk of certain adverse obstetrical and perinatal outcomes. These patients may benefit from enhanced supports and a care plan aimed at optimizing pregnancy outcomes.
引用
- Zipursky JS, Vigod SN, Babujee A, et al. Maternal attention deficit hyperactivity disorder and adverse obstetrical and perinatal outcomes: A population-based cohort study in Ontario, Canada. Am J Obstet Gynecol MFM. 2026. PMID: 41990995. doi:10.1016/j.ajogmf.2026.101969
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。