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Risk of intellectual disability and maternal history of spontaneous abortion: a nationwide cohort study
Author(s) -
Ji Honglei,
Yu Yongfu,
Miao Maohua,
Qian Xu,
Yuan Wei,
Lin Yi,
Liang Hong,
Li Jiong
Publication year - 2021
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14839
Subject(s) - abortion , medicine , hazard ratio , confidence interval , obstetrics , cohort study , pregnancy , intellectual disability , cohort , odds ratio , proportional hazards model , pediatrics , psychiatry , surgery , genetics , biology
Aim To investigate the association between a maternal history of spontaneous abortion and intellectual disability in children. Method This cohort study included 1 778 786 children (913 340 males, 865 085 females, 361 missing data; mean age 15y 2mo, SD 8y 11mo, range birth to 40y) born in Denmark between 1977 and 2016. Cox proportional hazard regression was used to estimate the hazard ratios (HRs) of intellectual disability. Results The overall HR of intellectual disability for children with a maternal history of spontaneous abortion was 1.17 (95% confidence interval [CI] 1.12–1.22) and the risk for multiple spontaneous abortions (HR=1.30, 95% CI 1.20–1.40) was higher than for a single spontaneous abortion (HR=1.13, 95% CI 1.07–1.18). When only cases of inpatient intellectual disability were included, the estimates increased slightly: the overall HR was 1.22 (95% CI 1.12–1.32), the HR for multiple spontaneous abortions was 1.37 (95% CI 1.20–1.58), and the HR for a single spontaneous abortion was 1.17 (95% CI 1.07–1.28). The risks were similar regardless of whether spontaneous abortion occurred before or after the index delivery. Estimates were nearly unchanged after adjusting for preterm birth, low birthweight, or Apgar score. Interpretation Children born to mothers with spontaneous abortion, especially multiple spontaneous abortions, may be at a higher risk of intellectual disability in later life, regardless of whether spontaneous abortion occurred before or after the index delivery. The findings have clinical implications for targeted early intervention of children with intellectual disability.What this paper adds A maternal history of spontaneous abortion was associated with a risk of intellectual disability in offspring. The risk was higher in children whose mothers previously had multiple spontaneous abortions. Similar risks were observed regardless of whether spontaneous abortion occurred before or after childbirth.