母孕期相关因素与儿童智力发育障碍/全面发育迟缓严重程度的关联

Maternal pregnancy-related factors associated with the severity of intellectual developmental disorder/global developmental delay in children

摘要

目的 探讨母孕期相关因素与智力发育障碍/全面发育迟缓患儿(IDD/GDD)临床严重程度的关联,为IDD/GDD患儿的分层管理与早期干预提供线索。方法 选取2022年10月—2025年3月西安中医脑病医院收治的275例IDD/GDD患儿为研究对象,采用Gesell发育诊断量表或韦氏儿童智力量表(第四版)评估患儿发育商(DQ)或总智商(FSIQ),采用婴儿-初中生社会生活能力量表评定社会适应能力。依据病史、临床表现及标准化评估结果将患儿分为轻度组(87例),中度组(77例),重度组(111例),经单因素分析筛选变量后,以轻度组为参照,采用多因素logistic回归模型,分析各因素与IDD/GDD严重程度的关联。结果 单因素分析显示,高龄孕母、妊娠期缺铁性贫血(IDA)、孕期电磁场暴露＞10h/d、孕早期呼吸道病毒感染在组间分布差异有统计学意义(P＜0.05)。多因素logistic回归分析结果显示:母亲IDA与患儿重度IDD/GDD相关(OR=2.310,95%CI: 1.123~4.752,P＜0.05);孕早期呼吸道病毒感染(中度:OR=2.338,95%CI: 1.009~5.419;重度:OR=3.387,95%CI: 1.590~7.214)、孕期电磁场暴露＞10h/d(中度:OR=3.227,95%CI: 1.174~8.873;重度:OR=2.788,95%CI: 1.032~7.531)与患儿病情程度较高相关(P＜0.05);孕母高龄与中度IDD/GDD相关(OR=2.891,95%CI:1.084～7.705,P＜0.05)。结论 在IDD/GDD患儿中,母体IDA和孕早期呼吸道病毒感染与重度障碍独立关联,提示产前铁缺乏与母体免疫激活可能参与疾病严重程度的分化,建议加强母孕期的铁营养检测与孕早期的感染防控。

Abstract

Objective To investigate the associations between maternal pregnancy-related factors and the clinical severity of intellectual developmental disorder/global developmental delay (IDD/GDD) in children, in order to provide evidence for risk stratification and early intervention. Methods A total of 275 children with IDD/GDD who were treated at Xi′an Encephalopathy Hospital of Traditional Chinese Medicine between October 2022 and March 2025 were included.Developmental quotient (DQ) or full-scale intelligence quotient (FSIQ) was assessed using the Gesell Developmental Schedule or the Wechsler Intelligence Scale for Children, Fourth Edition, respectively.Social adaptive functioning was evaluated usingthe Normal Development of Social Skills from Infancy to Junior High School Children.According to medical history,clinical manifestations, and standardized assessments, the children were categorized into mild (n=87), moderate (n=77), and severe (n=111) groups.Variables identified by univariate analysis were entered into a multinomial logistic regression model to examine their associations with IDD/GDD severity, with the severe group as the reference category. Results Univariate analysis showed significant differences in advanced maternal age, maternal iron-deficiency anemia (IDA), electromagnetic-field exposure for >10 h/d during pregnancy and respiratory viral infection during early pregnancy among three groups (P<0.05).In multionmial logistic regression analyses,maternal IDA was associated with severe IDD/GDD in children (OR=2.310, 95%CI: 1.123 - 4.752,P<0.05).EPRVI (moderate: OR=2.338, 95%CI: 1.009 - 5.419; severe: OR=3.387, 95%CI:1.590 - 7.214) and prenatal electromagnetic field exposure >10 h/day (moderate:OR=3.227,95%CI:1.174 - 8.873;severe:OR=2.788,95%CI:1.032 - 7.531)were associated with higher severity levels of IDD/GDD (P<0.05).Advanced maternal age was associated with moderate IDD/GDD (OR=2.891, 95%CI: 1.084 - 7.705,P<0.05). Conclusions Maternal IDA and respiratory viral infection during early pregnancy are independently associated with severe IDD/GDD, suggesting that prenatal iron deficiency and maternal immune activation may contribute to variation in disease severity.Enhanced monitoring of maternal iron status and prevention of infection during early pregnancy may be warranted.

关键词

智力发育障碍 / 全面发育迟缓 / 妊娠期 / 缺血性贫血 / 呼吸道病毒感染

Key words

intellectual developmental disorder / global developmental delay / pregnancy / iron-deficiency anemia / respiratory viral infection

[1] 朱红敏, 袁纯辉.儿童神经发育障碍疾病研究进展[J].中国当代儿科杂志, 2023, 25(1): 91-97.
Zhu HM, Yuan CH.Recent research on neurodevelopmental disorders in children[J].Chin J Contemp Pediatr, 2023, 25(1): 91-97.(in Chinese)
[2] Pinals DA, Hovermale L, Mauch D, et al.Persons with intellectual and developmental disabilities in the mental health system: Part 1.clinical considerations[J].Psychiatr Serv, 2022, 73(3): 313-320.
[3] Maenner MJ, Blumberg SJ, Kogan MD, et al.Prevalence of cerebral palsy and intellectual disability among children identified in two U.S.National Surveys, 2011—2013[J].Ann Epidemiol, 2016, 26(3): 222-226.
[4] Rodan LH, Stoler J, Chen E, et al.Geneticevaluation of the child with intellectual disability or global developmental delay: Clinical report[J].Pediatrics, 2025, 156(1): e2025072219.
[5] Greene D, Thys C, Berry IR, et al.Mutations in the U4 snRNA gene RNU4-2 cause one of the most prevalent monogenic neurodevelopmental disorders[J].Nat Med, 2024, 30(8): 2165-2169.
[6] Leonard H, Montgomery A, Wolff B, et al.A systematic review of the biological, social, and environmental determinants of intellectual disability in children and adolescents[J].Front Psychiatry, 2022, 13: 926681.
[7] Mckinney WS, Williford DN, Abbeduto L, et al.The impact of social-environmental factors on IQ in syndromic intellectual developmental disabilities[J].J Clin Transl Sci, 2024, 8(1): e59.
[8] 中华预防医学会生命早期发育与疾病防控专业委员会, 中华医学会围产医学分会, 中华医学会妇产科学分会产科学组.孕产妇血液管理专家共识[J].中华围产医学杂志, 2026, 29(2): 97-104.
Professional Committee on Early Life Development and Disease Prevention and Control, Chinese Preventive Medicine Association;Society of Perinatal Medicine, Chinese Medical Association;Obstetrics Subgroup, Society of Obstetrics and Gynecology, Chinese Medical Association.Expert consensus on patient blood management in pregnant and postpartum women[J].Chin J Perinat Med, 2026, 29(2): 97-104.(in Chinese)
[9] Levi S, Ripamonti M, Moro AS, et al.Iron imbalance in neurodegeneration[J].Mol Psychiatry, 2024, 29(4): 1139-1152.
[10] Theola J, Andriastuti M.Neurodevelopmental impairments as long-term effects of iron deficiency in early childhood: A systematic review[J].Balkan Med J,2025,42(2):108-120.
[11] 华梦迪, 耿凤基, 邵洁.早期缺铁与大脑认知发育的研究进展——从营养视角关注脑发育[J].早期儿童发展, 2023,1: 5-14.
Hua MD, Geng FJ, Shao J.Advances in the study of early iron deficiency and cognitive brain development—Focusing on brain development from a nutritional perspective[J].Early Child Dev, 2023,1: 5-14.(in Chinese)
[12] East PL, Doom JR, Blanco E, et al.Iron deficiency in infancy and sluggish cognitive tempo and ADHD symptoms in childhood and adolescence[J].J Clin Child Adolesc Psychol, 2023, 52(2): 259-270.
[13] 赵春, 王成举.铁与儿童精神运动发育、认知功能和神经行为关系的研究进展[J].中国儿童保健杂志, 2021, 29(8): 869-872.
Zhao C, Wang CJ.Research progress on the association between iron and psychomotor development, cognitive function and neurobehavioral in children[J].Chin J Child Health Care, 2021, 29(8): 869-872.(in Chinese)
[14] 傅晓燕, 谢晓恬.婴幼儿铁缺乏症与脑发育障碍相关性研究[J].中国当代儿科杂志, 2018, 20(11): 964-967.
Fu XY, Xie XT.Association between iron deficiency and brain developmental disorder in children[J].Chin J Contemp Pediatr, 2018, 20(11): 964-967.(in Chinese)
[15] Bian Q, Chen Y, Zhang J, et al.Maternal natural killer cells drive neuroimmune disorders in offspring through aberrant secretion of extracellular granzyme B[J].Immunity, 2025, 58(6): 1502-1518.e8.
[16] Yin Z, Gordon C, Zhou Z, et al.Maternal immune activation and neuropsychiatric disease in offspring: Pathogen′s perspective[J].Decod Infect Transm, 2024, 2: 100029.
[17] Peyre H, Rios P, Botton J, et al.Shared and disorder-specific prenatal and perinatal risk factors for neurodevelopmental disorders: A nationwide cohort study[J].Molecular Psychiatry, 2026, 31: 5162-5171.
[18] Khayat S, Fanaei H, Lakzaee N.Effects of prenatal mobile phone radiation exposure on MMP9 expression: Implications for inflammation, oxidative stress, and sensory-motor impairment after neonatal hypoxia-ischemia in rats[J].Toxicol Rep, 2023, 11: 378-384.
[19] 郭程, 余晓丹.全面发育迟缓儿童语言及社交早期干预研究进展[J].中国儿童保健杂志, 2025, 33(9): 987-991.
Guo C, Yu XD.Advances in early intervention for language and social development in children with global developmental delay[J].Chin J Child Health Care, 2025, 33(9): 987-991.(in Chinese)

基金资助

国家中医药管理局全国名老中医药专家传承工作室建设项目(2022);陕西省卫生健康委省级学科带头人访学研修经费资助(2025-56)