İsmail AKALTUN, ÖMER ERKAN YAPÇA, Hamza AYAYDIN, Tayfun KARA

An evaluation of attention deficit hyperactivity disorder and specific learning disorder in children born to diabetic gravidas: a case control study

Objective: Children born after risky pregnancies are known to have an increased disposition to neurodevelopmental disorders. The purpose of our study was to investigate the relationship between diabetic pregnancy and attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD). Methods: One hundred thirty-seven children of mothers with diabetic pregnancies and 128 children of mothers without a history of diabetic pregnancy were enrolled. Forty-nine of the case group had a history of insulin-dependent diabetes mellitus (IDDM) and 88 of gestational diabetes mellitus (GDM). All participants were evaluated using The Kiddie Schedule for Affective Disor- ders and Schizophrenia for School-Age Children (6-18) (K-SADS PL), the Wechsler Intelligence Scale for Children- Revised (WISC-R), and the SLD Battery. The results were then subjected to statistical analysis. Results: A statisti- cally significant difference was determined between the case and control groups in terms of levels of diagnosis of ADHD and SLD. Significant differences were determined between verbal/performance/total IQ scores when IDDM and GDM were compared with the control group. When the IDDM and GDM subgroups were compared among themselves, no significant difference was determined between verbal/performance/total IQ scores. Significant varia- tion was observed between the IDDM and GDM groups in terms of ADHD and SLD diagnoses. IQ scores decreased as fasting blood sugar increased in all parameters. Conclusion: Significantly, more diagnoses of ADHD and SLD were observed in children born to diabetic mothers compared to those of non-diabetic mothers. Further, wide- ranging studies on the subject of the effect of diabetic pregnancy and blood sugar control on infant neurodevel- opmental disorders are now needed. (Anatolian Journal of Psychiatry 2019; 20(4):442-448)

Diyabetik gebelerden doğan çocukların dikkat eksikliği hiperaktivite bozukluğu ve özgül öğrenme güçlüğü açısından değerlendirilmesi: Olgu kontrol çalışması

Amaç: Riskli hamileliklerden doğan çocuklarda nörogelişimsel bozukluklara eğilimin arttığı bilinmektedir. Çalışma- mızda diyabetik gebelik ile dikkat eksikliği hiperaktivite bozukluğu (DEHB) ve özgül öğrenme güçlüğü (ÖÖG) arasındaki ilişkiyi araştırmayı amaçladık. Yöntem: Bu çalışmaya, annelerinde diyabetik gebeliği olan 137 çocuk ile annesinde diyabetik gebelik öyküsü olmayan 128 çocuk alındı. Olgu gurubunda 49 katılımcının insüline bağımlı diyabetes mellitus (İBDM), 88 katılımcının gestasyonel diyabetes mellitus (GDM) öyküsü vardı. Tüm katılımcılar, Okul Çağı Çocukları için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi-Şimdi ve Yaşam Boyu Şekli (6- 18) (K-SADS PL), Wechsler Çocuklar için Zeka Testi (WISC-R), ÖÖG Bataryası ile değerlendirildi. Elde edilen sonuçlar istatistiksel olarak karşılaştırıldı. Bulgular: Olgu ve kontrol grupları arasında DEHB ve ÖÖG tanısı oranları arasında istatistiksel olarak anlamlı fark vardı. İBDM ve GDM ile kontrol grubu karşılaştırıldığında sözel/performans/ toplam IQ puanları arasında anlamlı fark saptandı. İBDM ve GDM kendi içlerinde karşılaştırıldığında sözel/perfor- mans/toplam IQ puanları arasında anlamlı fark saptanmadı. IDDM ve GDM grupları arasında DEHB ve ÖÖG tanıları arasında anlamlı fark olduğu görüldü. Tüm parametrelerde açlık kan şekeri (AKŞ) arttıkça IQ puanlarında düşüş olduğu görülmüştür Sonuç: Diyabetik gebelerden doğan çocuklarda DEHB ve ÖÖG tanılarının diyabetik olmayan gebelerden doğan çocuklara göre daha fazla olduğu görüldü. Diyabetik gebeliğin ve kan şekeri kontrolünün, bebek- lerin nörogelişimsel bozukluklar üzerine etkisi konusunda daha geniş kapsamlı çalışmalara gerek vardır. (Anadolu Psikiyatri Derg 2019; 20(4):442-448)

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Paule MG, Rowland AS, Ferguson SA, Chelonis JJ, Tannock R, Swanson JM, et al. Attention deficit/hyperactivity disorder: characteristics, interventions and models. Neurotoxicol Teratol 2000; 22:631-651.

Silver CH, Ruff, RM, Iverson GL, Barth JT, Broshek DK, Bush SS, et al. Learning disabilities: the need for neuropsychological evaluation. Arch Clin Neuropsychol 2008; 23:217-219.

Rutter M, Caspi A, Fergusson D, Horwood LJ, Goodman R, Maughan B, et al. Sex differences in developmental reading disability: new findings from 4 epidemiological studies. JAMA 2004; 291:2007-2012.

Germano E, Gagliano A, Curatolo P. Comorbidity of ADHD and dyslexia. Dev Neuropsychol 2010; 35:475-493.

DuPaul GJ, Volpe RJ. ADHD and learning disabi- lities: Research findings and clinical implications. Curr Atten Disord Reports 2009; 1:152-155.

Moreau D, Waldie KE. Developmental learning disorders: from generic ınterventions to individua- lized remediation. Front Psychol 2015; 6:2053.

Moll K, Göbel SM, Gooch D, Landerl K, Snowling MJ. Cognitive risk factors for specific learning dis- order processing speed, temporal processing, and working memory. J Learn Disabil 2016; 49:272- 281.

Biederman J, Faraone SV. Attention-deficit hyper- activity disorder. Lancet 2005; 366:237-248.

Biederman J. Attention-deficit/hyperactivity disor- der: a selective overview. Biol Psychiatry 2005; 57:1215-1220.

McCracken JT. Attention-deficit disorders. Sa- dock BJ, Sadock VA (Eds.), Comprehensive Text- book of Psychiatry, seventh ed., Philadelphia: Lippincott Williams and Wilkins, 2000, pp.2679- 2682.

Arnold LE. Learning disorders. B Garfinkel, G Carl- son, E Weller (Eds.), Psychiatric Disorders in Chil- dren and Adolescents. USA: WB Saunders, 1990, pp.237-256.

Silver LB. Learning disabilities. J Am Acad Child Adolesc Psychiatry 1989; 28:309-313.

Fraser A, Lawlor DA. Long-term health outcomes in offspring born to women with diabetes in preg- nancy. Curr Diab Rep 2014; 14:489.

Alur P, Kodiyanplakkal P, Del Rosario A, Khub- chandani S, Alur R, Moore JJ. Epidemiology of infants of diabetic mothers in indigent Micronesian population-Guam experience. Pac Health Dialog 2002; 9:219-221.

Wender-Ozegowska E, Wroblewska K, Zawiejska, Pietryga M, Szczapa J, Biczysko R. Threshold values of maternal blood glucose in early diabetic pregnancy-prediction of fetal malformations. Acta Obstet Gynecol Scand 2005; 84:17-25.

Hay WW, Rozance PJ. Continuous glucose moni- toring for diagnosis and treatment of neonatal hypoglycemia. J Pediatr 2010; 157:180-182.

Rizzo TA, Dooley SL, Metzger BE Cho NH, Ogata ES, Silverman BL. Prenatal and perinatal influ- ences on long-term psychomotor development in offspring of diabetic mothers. Am J Obstet Gynecol 1995; 173:1753-1758.

Gin H, Vambergue A, Vasseur C, Rigalleau V, Dufour P, Roques A, et al. Blood ketone moni- toring: a comparison between gestational diabetes and nondiabetic pregnant women. Diabet Metab 2006; 32:592-597.

Ornoy A, Ratzon N, Greenbaum C, E Peretz, D Soriano, M Dulitzky. Neurobehaviour of school age children born to diabetic mothers. Arch Dis Child Fetal Neonatal Ed 1998; 79:94-99.

Accardo PJ, Blondis TA, Whitman BY. Disorders of attention and activity level in a referral population. Pediatrics 1990; 85:426-431.

Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144:768-773.

Gökler B, Ünal F, Pehlivantürk B, Çengel-Kültür E, Akdemir D, Taner Y. Reliability and validity of sche- dule for affective disorders and schizophrenia for school age children-present and lifetime version- Turkish version (K-SADS-PL-T). Turk J Child Adolesc Mental Health 2004; 11:109-116.

Korkmazlar Ü. Özel Öğrenme Bozukluğu (6-11 yaş ilkokul çocuklarında özel öğrenme bozukluğu ve tanı yöntemleri). İstanbul: Taç Ofset, 1993.

Savaşır I, Şahin N. Wechsler Çocuklar için Zeka Ölçeği (WISC-R) Uygulama Kitapçığı. Ankara: Türk Psikologlar Derneği, 1995.

Nielsen GL, Andersen E, Lundbye-Christensen S. Maternal blood glucose in diabetic pregnancies and cognitive performance in offspring in young adulthood: a Danish cohort study. Diabet Med 2010; 27:786-790.

Ornoy A. Growth and neurodevelopmental outcome of children born to mothers with pregesta- tional and gestational diabetes. Pediatr Endoc- rinol Rev 2005; 3:104-113.

Ornoy A, Reece EA, Pavlinkova G, Kappen C, Miller RK. Effect of maternal diabetes on the embryo, fetus, and children: congenital anoma- lies, genetic and epigenetic changes and devel- opmental outcomes. Birth Defects Res C Embryo Today 2015; 105:53-72.

Instanes JT, Halmoy A, Engeland A, Haavik J, Furu K, Klungsøyr K. Attention-deficit/hyperactivity dis- order in offspring of mothers with inflammatory and immune system diseases. Biol Psychiatry 2017; 81:452-459.

Veena SR, Krishnaveni GV, Srinivasan K, Kurpad AV, Muthayya S, Hill JC, et al. Childhood cognitive ability: relationship to gestational diabetes mellitus in India. Diabetologia 2010; 53:2134-2138.

Bonilla C, Lawlor D, Ben-Shlomo Y, Ness AR, Gunnell D, Ringet SM et al. Maternal and offspring fasting glucose and type 2 diabetes-associated genetic variants and cognitive function at age 8: a Mendelian randomization study in the Avon Longi- tudinal Study of Parents and Children. BMC Med Genet 2012; 27:13-90.

Fraser A, Almqvist C, Larsson H, Långström N, Lawlor DA. Maternal diabetes in pregnancy and offspring cognitive ability: sibling study with 723,775 men from 579,857 families. Diabetologia 2014; 57:102-109.

Nielsen GL, Dethlefsen C, Sørensen HT, Peder- sen JF, Molsted-Pedersen L. Cognitive function and army rejection rate in young adult male off- spring of women with diabetes: a Danish popula- tion-based cohort study. Diabetes Care 2007; 30:2827-2831.

Daraki V, Roumeliotaki T, Koutra K, Georgiou V, Kampouri M, Kyriklaki A, et al. Effect of parental obesity and gestational diabetes on child neuro- psychological and behavioral development at 4 years of age: the Rhea mother-child cohort, Crete, Greece. Eur Child Adolesc Psychiatry 2017; 26:703-714.

Ornoy A, Wolf A, Ratzon N, Greenbaum C, Dulitz- ky M. Neurodevelopmental outcome at early school age of children born to mothers with gesta- tional diabetes. Arch Dis Child Fetal Neonatal 1999; 81:10-14.

Ornoy A, Ratzon N, Greenbaum C, Peretz E, Soriano D, Dulitzky M. School-age children born to mothers with pregestational or gestational dia- betes exhibit a high rate of inattention and fine and gross motor impairment. J Pediatr Endocrinol Metab 1998; 79:94-99.

Churchill JA, Berendes HW, Nemore J. Neuro- psychological deficits in children of diabetic moth- ers: a report from the collaborative study of cereb- ral palsy. Am J Obstet Gynecol 1969; 105:257-268.

Schmitt J, Romanos M. Prenatal and perinatal risk factors for attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 2012; 166:1074-1075.