167. ADHD mothers, COVID and ACEI, Near Sighted Children

Autoimmune mothers likely don't actually have more ADHD kids. If you patient is in the hospital we now have a RCT to answer the question about ACEI starting or stopping. Finally, there are problems around COVID we don't even know about and it has nothing to do with contracting COVID19.





Association of Maternal Autoimmune Disease With Attention-Deficit/Hyperactivity Disorder in Children | Attention Deficit/Hyperactivity Disorders | JAMA Pediatrics | JAMA Network

Doesn't say what the authors think that it says – or perhaps it does and that is the problem with most studies in pregnancy….

The authors conclusions were “In this cohort study, maternal autoimmune diseases were associated with increased ADHD among children.”

Wiat autoimmune disorders in mom and boom big time risk of ADHD in children!

Better brain has true celiac so this is something I am interested—it sparked my attention!

population-based cohort analysis of 831,718 infants and mothers

in the end the researchers matched almost 13,000 children whose mother's had an autoimmune disease with approximately 50,000 children whose mothers did not have an autoimmune disease and when they crunch through all of the numbers those individuals whose mothers did not have an autoimmune disease were diagnosed with ADHD 5.48 cases per 1000 boys and 1.70 per 1000 girls BUT if your mom had an autoimmine disease then your risk of ADHD SHOT UP. From 5.5 for boys to 6.9 and from 1.7 for girls to 2.3. Yes that’s right an extra case of ADHD for every 700boys and an extra case of ADHD for every 2000 girls---

multiple things about the study- first of all not very impressed by the findings. Ousley is a cohort study so they're just looking at groups of patient's at different points of time. However may be the mothers who have autoimmune disorders are more likely to go to the doctor for their illness and thus more likely to take the child to the doctor. Or mothers who have autoimmune disorders are probably more likely to have health insurance for their medical condition and thus more likely once again to take their children to the doctor. After all he can be diagnosed with ADHD or any other illness unless you go to the doctor to get the diagnosis.

Next this is a perfectly example of absolute and relative risk reduction which is often miss under still by many medical students, resident's, and even attending physicians.

Left look at the event rate of ADHD in girls. It was 1.7 per thousand for those individuals who did not have a mother with an autoimmune disorder and the event rate went up to 2.3 cases of ADHD per thousand for those girls whose mother has an autoimmune disorder. The difference between 1.7 and 2.3 is 0.5. Thus you could say that if you have a mother with an autoimmune disease then there is a 0.5 per thousand increase rate of ADHD. Or since 0.5 is about a third or 33% of of 1.7- I could potentially say that having a mother with an autoimmune disorder increases your risk of ADHD as a female child by 33%.

In both statements I'm saying the same thing-------------- rant

A reminder- The authors conclusions were “In this cohort study, maternal autoimmune diseases were associated with increased ADHD among children.”

So maybe this article does say what the authors think that it said but unless you read the article you might be tricked into thinking that this was a substantial finding and worth long debates and discussion about.
One of many problems with pregnancy litature is the small almost insignificant findings.
you see there actually was an increase but that increase was so small---- the reason being is that most pregnancies go off without a hitch. Most pregnancies don't have any complications. Most pregnancies that are carried to term delivery are absolutely fine so when you find even a small increase in the numbers you can report regardless if it worth your time to know about or think about.


The next article is the ultimate questiongin medicine article

Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial | Critical Care Medicine | JAMA | JAMA Network


Remember at the beginning of covid I did a podcast and I talked about ACE and ARBs and said I am still writing for them. This belief the are bad comes from bad evidence

Actually not even evidence—just opinion pieces such as a piece in journal of htn back in may titled-

Like Can angiotensin receptor-blocking drugs perhaps be harmful i... : Journal of Hypertension (lww.com)

Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic?

Some of us stopped acei on everyone. You make a fancy little drawing and explaination of a possible mechanism and many people fall victim and believe you. This is why drug reps are so successful. For majority of physicians they don't actually have the prove any benefit or outcome just a bunch of drawings with fancy words and potential mechanisms of how it could work. Others of us demand hard outcomes and appropriate clinical trials
Well now we have our results in this JAMA article which is the first randomized control trial of roughly 650 patient's hospitalized with mild to moderate COVID-19 who were taking either an ACE inhibitor or an angiotensin II receptor blockers (ARBs) on admission.
Patient's were then randomized to either discontinue the ACE inhibitor or angiotensin II receptor blocker or to continue it.
The primary outcome was the number of days alive and out of the hospital after 30 days. The secondary outcomes included death, cardiovascular death, and COVID-19 progression

And there was absolutely no difference no matter what you looked at

Continue the ACE OR ARB when you patient is admitted to the hospital with mild to moderate covid19

And the last article should make you think
Make you think

Progression of Myopia in School-Aged Children After COVID-19 Home Confinement | Global Health | JAMA Ophthalmology | JAMA Network

There are problems with covid 19 we cant even see yet. They have nothing to do with getting covid. They have to do with not getting covid. The social isolation is one of them but another one is the concern is whether home confinement 4 children may have a burden on their eyes. Less time outside = less time playing and more time inside likely in front of some sort of screen whether it be a computer screen or a TV screen or a tablet screening.

So in the study the authors set out to fine if the prevalence of myopia in school children during Covid 19 was affected. The theory being that children are spending more time in front of a screen and less time outside and thus the eyes are not encouraged to grow any look for anything greater than something that is 2 feet in front of the face. This study was paced out of China however I think that the results of likely applicable to everyone. Photoscreenings have been performed annually on children in 10 elementary schools since 2015- this is usually over 100,000 children participating each year.

In each ear the authors calculated an estimated prevalence of myopia
And in 2020 the rates of myopia s/p covid quartine the changes were scary. For 8yr olds the prevalence in previous years was 27% and it jumped up to 37%. For seven year olds the prevalence was 16% and jumped up to 26% and for 6 year olds the prevelance of myopia was 5.7% and relatively speaking it jumped up 400% or and absolute of 21%

This substantial myopic shift was not seen in any other year-to-year comparison,

What does this mean?? Sure there is a change but what does it mean?? And the answer is we don’t totally know and we wont know

We do know currently that 1 in 3 people with high myopia becomes severely visually impaired, mostly at working age. So the potential health problem is very bad.

This is not me saying we shouldn’t have shut down at the beginning
But this is me saying that it is sad some of the problems we don’t even realize we have or will have because of the covid19 pandemic
Much of the pandemic became a political issue which only hurts the patient when medical clarity is clouded by political preference.