基于纵向队列的喂养方式对婴儿心理发育的影响研究

Influence of feeding patterns on the psychological development of infants based on a longitudinal cohort

摘要

目的 通过队列研究探索婴儿早期喂养方式对其6月龄心理发育的影响,为婴幼儿科学喂养和发育促进提供证据支持。方法 采用多中心前瞻性队列研究设计,于2019年在4所省市级妇幼保健院招募3月龄婴儿417名,根据喂养方式分为纯母乳喂养组和人工喂养组,随访至6月龄时采用《年龄与发育进程问卷第三版》(ASQ-3)对婴儿沟通、粗大动作、精细动作、解决问题和个人-社会能力5个能区的心理发育进行评估。使用单因素分析、多重线性回归模型探究婴儿心理发育与喂养方式的关系及影响因素。结果 本研究共纳入369人,其中纯母乳喂养218人(59.08%),人工喂养151人(40.92%)。纯母乳喂养组ASQ总分为(246.768±35.834)分,人工喂养组为(230.042±45.322)分,差异有统计学意义(t=3.697,P＜0.001);各能区得分比较显示,纯母乳喂养组婴儿粗大动作、精细动作、解决问题、个人-社会能区的得分也均高于人工喂养组,差异有统计学意义(t＝3.653、2.079、2.746、3.777,P<0.05)。通过多重线性回归分析,控制婴儿性别、民族、分娩方式、母亲年龄、母亲受教育程度、家庭结构、家庭人均月收入和是否独生等因素影响,发现3月龄纯母乳喂养是婴儿6月龄心理发育的保护因素(β=15.106,95%CI:6.790~23.421); 特别是对粗大动作(β=4.767,95%CI:1.886~7.649)、精细动作(β=2.158,95%CI:0.050~4.267)、解决问题(β=2.834,95%CI:0.755~4.912)和个人-社会(β=4.671,95%CI:1.905~7.437)等能区有保护效应。结论 婴儿3月龄内的纯母乳喂养方式对6月龄时心理发育具有积极促进作用。

Abstract

Objective To explore the influence of early infant feeding practices on psychological development at 6 months of age through a cohort study, so as to provide evidence-based support for scientific infant feeding and developmental promotion. Methods A multicenter prospective cohort study design was adopted, recruiting 417 infants aged 3 months from four municipal and provincial maternal and child health hospitals in 2019.Infants were divided into exclusive breastfeeding and formula feeding groups based on their feeding mode, and were followed up until 6 months of age when their psychological development was assessed using the Ages and Stages Questionnaires, Third Edition (ASQ-3) across five domains: communication, gross motor, fine motor, problem-solving, and personal-social skills.Univariate analysis and multiple linear regression models were used to explore the relationship between infant psychological development and feeding practices, as well as influencing factors. Results A total of 369 infants were included, with 218 (59.08%) in the exclusive breastfeeding group and 151 (40.92%) in the formula feeding group.The mean ASQ total score was 246.768±35.834 for the exclusive breastfeeding group was significantly higher than that in the formula feeding group (230.042±45.322) (t=3.697, P<0.001).Comparisons of scores across domains showed that infants in the exclusive breastfeeding group also significantly scored higher in gross motor, fine motor, problem-solving, and personal-social skills (P<0.05).After controlling for factors such as infant gender, ethnicity, delivery mode, maternal age, maternal education level, family structure, monthly per capita household income, and whether the infant was an only child, multiple linear regression analysis revealed that exclusive breastfeeding at 3 months of age was a protective factor for infant psychological development at 6 months (β=15.106,95%CI: 6.790 - 23.421), particularly for the gross motor (β=4.767, 95%CI:1.886 - 7.649), fine motor (β=2.158, 95%CI: 0.050 - 4.267), problem-solving (β=2.834, 95%CI:0.755 - 4.912), and personal-social domains (β=4.671, 95%CI: 1.905 - 7.437). Conclusions Exclusive breastfeeding within the first 3 months of life positively promotes infants′ psychological development at 6 months of age.

关键词

纯母乳喂养 / 人工喂养 / 婴儿 / 心理发育 / 队列研究

Key words

exclusive breastfeeding / formula feeding / infants / psychological development / cohort study

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基金资助

国家自然科学青年基金(81803249);中国疾病预防控制中心青年基金(2018A202)