Association Between Dietary Patterns During Pregnancy,pregnancy-related Anxiety And ADHD Symptoms In Preschoolers:A Population-based Birth Cohort Study

ObjectivesThe aim of this study was to obtain the dietary patterns during the pregnant period,describe the distribution of pregnancy-related anxiety symptoms and preschoolers' ADHD symptoms in Ma'anshan city.And further to explore the association between dietary patterns,pregnancy-related anxiety and preschoolers' ADHD symptoms.MethodsThe present study involved the sub-study of China-Anhui birth cohort study(C-ABCS)-Ma'anshan birth cohort,which recruited pregnant woman between November 2008 and October 2010.Women were recruited at their first antenatal examination in the Ma'anshan Maternal and Child Health Hospital if they fulfilled the following inclusion criteria: intention to deliver in the reference hospital,with gestational weeks ? 28 weeks,without mental disorders and without communication disorders.All participants completed questionnaires during the first,second and third trimester.The food frequency questionnaire were used to evaluate the dietary patterns.Maternal mental health status were assessed by pregnancy-related anxiety scale.A total of 5 084 pregnant women were enrolled in the original birth cohort,4 669 had singleton live births.Seven wave follow-up was conducted to obtain preschoolers' development between April 2014 and June 2015.The Health and Behavior Record Form for Preschoolers were completed by their parents.The 10-item Conners' Abbreviated Symptom Questionnaire(C-ASQ,Chinese version)was used to assess ADHD symptoms of the preschoolers.Maternal who without diet and mental health information and children who without ADHD symptom assessment were excluded.Finally,a total 3 682 mother-child pairs were included in the present study.Principal component analysis(PCA)were performed to extract dietary patterns.The dietary pattern was divided into T1(low score)and T2(high score)according to the factor scores.Chi-square test was used to describe the distribution of pregnancy-related anxiety and preschoolers' ADHD symptoms.The binary logistic regression were fitted to explore the association between maternal dietary patterns and pregnancy-related anxiety symptoms and preschoolers' ADHD symptoms.Multi-classification logistic regression were used to investigate the combined exposure effects on preschoolers' ADHD symptoms.ResultsThe dietary patterns during the first and second trimester can generate into five types: meat type,balanced type,traditional type,beverage type and processed type.There are 25.2%(928/3 682)and 14.1%(518/3 682)maternal had pregnancy-related anxiety symptoms during the first and third trimester,respectively.The detection rate of ADHD symptoms in preschoolers was 9.3%(344/3 682).In the first trimester,maternal who with “balanced” and “traditional” dietary patterns had lower rates of pregnancy-related anxiety symptoms,while those with “beverage” and “processed”dietary patterns had higher rates of pregnancy-related anxiety symptoms;maternal who with “traditional” dietary pattern had a lower rate of pregnancy-related anxiety symptoms in the third trimester.In the second trimester,the maternal with “balanced”dietary pattern had a lower rate of pregnancy-related anxiety symptoms in the third trimester of pregnancy,while those with “processed” dietary pattern had higher rates of pregnancy-related anxiety symptoms.After adjusting the confounding factors,it was found that there was no significant correlation between the dietary patterns in the first trimester of pregnancy and ADHD symptoms of preschoolers(P>0.05).With the low scores group as the control group,maternal had a high scores in the“processed”dietary pattern in the second trimester of pregnancy increased the risk of ADHD symptoms among preschoolers(OR = 1.44,95%CI:1.09-1.91).Compared with those who without anxiety,pregnancy-related anxiety symptoms in the first trimester(OR = 1.52,95%CI:1.14-2.04)and third trimester(OR = 1.65,95%CI:1.18-2.33)increased the risk of preschoolers' ADHD.The effect of combined exposure of pregnancy dietary patterns and pregnancy related anxiety symptoms on the occurrence of ADHD symptoms in preschoolers was analyzed.The maternal who had no anxiety both in the first and third trimester as well as had a low scores in the “processed” dietary pattern in the second trimester were taken as the control group,maternal with anxiety in the first and third trimester and high scores in the “processed” dietary pattern in the second trimester had a significantly higher risk of ADHD symptoms in their offspring(OR = 2.35,95%CI:1.34-4.14).The risk of ADHD in the preschoolers of maternal with high scores of“processed”dietary pattern in the second trimester and with anxiety in the first trimester was about 1.83 times higher than that in the control group(OR = 1.83,95%CI:1.14-2.95),the risk of ADHD in the offspring of maternal with anxiety in the first and third trimester and low scores in the “processed” dietary pattern in the second trimester was about 2.07 times higher than that in the control group(OR = 2.07,95%CI:1.02-4.20).ConclusionsThe maternal dietary patterns in Ma'anshan city are diverse,the rate of pregnancy-related anxiety symptoms is higher in maternal with poor dietary patterns during pregnancy.The risk of preschoolers' ADHD symptoms are significantly increased when the “processed” dietary pattern and anxiety coexist during pregnancy.