A letter to the editor: “The association between congenital heart disease and the risk of autism spectrum disorders or attention-deficit/hyperactivity disorder among children: a meta-analysis”

Ramu, Aashraya; Srinivas, Sushma; Honest, Alex; Mansuri, Zeeshan; Jain, Shailesh

doi:10.1016/j.ejpsy.2022.07.002

ISSN: 0213-6163

The European Journal of Psychiatry is a quarterly publication founded in 1986 and directed by Professor A. Seva until his death in 2004. The journal is indexed in different bibliographic data bases, including the Social Sciences Citation Index. It is supported by the Spanish Society of Psychiatry and Mental Health, has been open to contributions from all over the world, and also has North American and Asian-Pacific co- editors. A new stage of development of the journal has started in 2017. A new Editorial Board has been appointed and an advanced on-line editorial system has been implemented. Our new publishing partners will help to assure that our valuable research gets broadly disseminated, providing a more accessible entry into our contribution. The overriding criteria for publication are originality, a high scientific quality and interest to a wide audience of those concerned with all aspects of mental illness. The scope is broad and the journal is committed to present new developments in the full spectrum of issues related to psychiatry and mental health, in areas linked to biological, psychological and social sciences. It will include basic studies and the growing application of clinical laboratory techniques in psychiatry. The European Journal of Psychiatry is determined to place particular emphasis on clinical issues related to a personalised medicine, including prevention and early intervention. All original papers will be refereed by independent experts in the field. Review articles and monographs designed to bring the reader up to date with research in the area will be a feature of the journal. There is a Book Review section and correspondence to the editor will be considered for publication. The journal will be of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in mental health professions, together with basic neurobiological researchers.

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We have read with great interest the excellent paper “The association between congenital heart disease and the risk of autism spectrum disorders or attention-deficit/hyperactivity disorder among children: a meta-analysis” by Jenabia et al.1 The study showed that congenital heart disease could lead to neurodevelopmental abnormalities in children. We want to make a few contributions to further scientific discourse.

It is unclear what duration of fetal hypoxia results in autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD) and what the critical period of gestational during which hypoxia affects the fetus’ oxygen-sensitive central nervous system area. The risk factors such as preeclampsia, smoking, Alcohol Use Disorder, viral infections, medications, thyroid deficiency, Toxoplasmosis, Rubella, Chlamydia, Herpes and Syphilis infections, anemia, hypertension, or any other factors can cause oxygen-deficient status in the mother resulting in hypoxia in the fetus and can lead to adverse neurodevelopmental outcomes.2,3 Congenital anomalies in the offspring that could temporarily cause intrauterine hypoxia can directly affect the development of ASD2 and ADHD3 in the baby. Not having done subgroup analysis on the type of chronic heart disease (CHD) (cyanotic or acyanotic) was acknowledged as a limitation by the authors. Still, the severity of hypoxemia (mild Ventricular Septal defect (VSD) vs. moderate VSD, muscular versus membranous) could determine the extent of neurodevelopmental outcomes, which could be the future direction for researchers. Likewise, conditions like transient tachypnea of the newborn or complications like cord compression can be confounders as they—like CHD, could cause hypoxia. Further, the timely management of CHD in the baby may affect the level and duration of hypoxia and the risk of developing ASD and ADHD and should be factored into the association between CHD and ASD and ADHD.4

We know that some genetic causes and syndromes may underlie a cluster of CHD and, ASD, ADHD. In velocardiofacial syndrome, the psychotic disorder may change the association between CHD and ASD and ADHD in complex yet not understood ways.5

We believe future directions would be for studies to consider all these aspects to inform clinical care by pediatric cardiologists and child and adolescent psychiatrists.

Ethical considerations

None.

Funding

None.

References

[1]

E. Jenabi, S. Bashirian, F. Fariba, B. Naghshtabrizi.

The association between congenital heart disease and the risk of autism spectrum disorders or attention-deficit/hyperactivity disorder among children: a meta-analysis.

Eur. J. Psychiatry, 36 ([Internet]. 2022), pp. 71-76

http://dx.doi.org/10.1016/j.ejpsy.2021.10.001

[2]

A. Modabbernia, E. Velthorst, A. Reichenberg.

Environmental risk factors for autism: an evidence-based review of systematic reviews and meta-analyses.

Mol. Autism, 8 ([Internet]. 2017), pp. 13

http://dx.doi.org/10.1186/s13229-017-0121-4 | Medline

[3]

E. Guney, F.H. Cetin, E. Iseri.

The role of environmental factors in etiology of attention- deficit hyperactivity disorder.

ADHD - new directions in diagnosis and treatment, InTech, (2015),

[4]