孕前及孕期相关因素对婴幼儿神经心理发育的影响研究

Influence of pre-pregnancy and pregnancy related factors on children's neuropsychological development

摘要

目的 探讨孕前及孕期相关因素对婴幼儿神经心理发育的影响,为促进其神经心理发育提供依据。方法 依托武汉妇儿健康宝贝出生队列项目,选取2016年7月至2018年9月在院建册和产检的孕妇,以招募获取的1019对母子作为研究对象.采用问卷形式收集孕妇孕前体质量指数(BMI)、怀孕年龄、孕次、职业、文化程度、分娩方式等信息;在婴幼儿2岁时采用贝利婴幼儿发展量表(中国城市修订版)(BSID-CR)测评其智力发展指数(MDI)和精神运动发展指数(PDI);将BSID-CR量表评分＞79分归为正常组,≤79分归为异常组.采用广义线性模型和Logistic回归模型对影响婴幼儿神经心理发育的孕前及孕期相关因素进行分析。结果 在1019名婴幼儿中,男童526名(51.6%)、女童493名(48.4%),MDI异常组86例(8.4%),PDI异常组21例(2.1%).在MDI中,正常组与异常组母亲怀孕年龄、孕前BMI的分布比较差异均有统计学意义(χ²值分别为9.239、7.481,P＜0.05).广义线性模型分析结果显示,母亲怀孕年龄与子代MDI之间存在负向关联:相比于母亲怀孕年龄为24~35岁,母亲怀孕年龄≥35岁的子代MDI降低6.913分(95%CI:-10.177~-3.650,P=0.001);母亲孕前BMI与子代MDI之间存在负向关联:相比于母亲孕前BMI正常,母亲孕前BMI为超重或肥胖的子代MDI降低4.380分(95%CI:-8.004~-0.755,P=0.018);母亲分娩孕周与子代PDI之间存在负向关联:相比于母亲分娩孕周为37~42周,母亲分娩孕周＜37周的子代PDI降低6.910分(95%CI:-12.766~-1.054,P=0.021).多因素Logistic回归模型分析显示,母亲怀孕年龄≥35岁(OR=1.749,95%CI:1.041~2.939,P=0.035)和母亲孕前BMI为超重或肥胖(OR=1.765,95%CI:1.016~3.065,P=0.044)均明显增加子代MDI异常的发生风险。结论 母亲高龄妊娠、孕前超重或肥胖及早产均可能是子代神经心理发育异常的高危因素,针对上述因素的及时干预有利于促进婴幼儿智力发育,提高人口素质.

Abstract

Objective To explore the influence of pre-pregnancy and pregnancy related factors on children's neuropsychological development, and to provide scientific reference for promoting their neuropsychological development. Methods Based on the Healthy Baby Cohort Study in Hubei province, pregnant women who were registered and had prenatal check-ups in the hospital from July 2016 to September 2018 were recruited, and 1019 mother-child pairs were included as study subjects. The information of body mass index (BMI), age at conception, parity, occupation, educational level and delivery mode were collected by questionnaire. The mental development index (MDI) and psychomotor development index (PDI) of the children were measured using the Bayley scales of infant development of China revision (BSID-CR) at the age of 2 years. BSID-CR scores ＞79 were classified as normal group and ≤79 as abnormal group. Generalized linear model and logistic regression model were used to analyze the factors affecting children's neuropsychological development before and during pregnancy. Results Among 1019 children, 526 (51.6%) were boys and 493 (48.4%) were girls, 86 (8.4%) were in abnormal MDI group and 21 (2.1%) were in abnormal PDI group. In MDI, the differences in the distribution of age at conception and pre-pregnancy BMI of mothers were statistically significant when comparing the normal and abnormal groups (χ²=9.239 and 7.481, respectively, P＜0.05). The results of the generalised linear model analysis showed a negative association between age at conception and offspring MDI: compared with the age at conception of 24-35 years, the offspring of mothers ≥35 years old had a lower MDI of 6.913 points (95%CI: -10.177--3.650, P=0.001). There was a negative association between maternal pre-pregnancy BMI and offspring MDI: offspring whose mothers' pre-pregnancy BMI was overweight or obese had a 4.380 points lower MDI compared to those whose mothers' pre-pregnancy BMI was normal (95%CI: -8.004--0.755, P=0.018). There was a negative correlation between gestational weeks and offspring PDI: compared with gestational weeks of 37-42 weeks, offspring with gestational week ＜37 weeks had a 6.910 points lower PDI (95%CI: -12.766--1.054, P=0.021). Multivariate logistic regression model analysis results showed that both age at conception ≥35 years (OR=1.749, 95%CI: 1.041-2.939, P=0.035) and pre-pregnancy BMI overweight or obese (OR=1.765, 95%CI: 1.016-3.065, P=0.044) significantly increased the risk of offspring MDI abnormalities. Conclusion Mothers' advanced pregnancy age, pre-pregnancy overweight or obesity and preterm birth may be the high risk factors for abnormal neuropsychological development of offspring. Timely intervention of these factors is beneficial to promote children's intellectual development and improve population quality.

关键词

婴幼儿 / 孕前 / 孕期 / 神经心理发育 / 相关因素

Key words

children / pre-pregnancy / pregnancy / neuropsychological development / related factors

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基金资助

武汉市卫生计生委科研项目(WX18D56)