母体妊娠合并症、孕期体重及喂养方式对子代神经行为发育的影响

Effects of maternal pregnancy complications, gestational weight, and feeding methods on neurobehavioral development in offspring

摘要

目的 探讨母体妊娠合并症、孕期体重增长和喂养方式对子代神经行为发育的影响。方法 采用回顾性队列研究,纳入527对母子,按妊娠合并症、孕期体重增长、喂养方式分别分组进行随访评估。采用盖塞尔发育量表评估婴儿6、12和18月龄的神经行为发育,运用多因素线性回归分析各影响因素的独立效应。结果 妊娠期糖尿病(GDM)组婴儿12月龄精细运动发育商(92.6±8.7)显著低于对照组(100.9±9.4,t= -6.12,P <0.01),18 月龄精细运动、适应性行为发育均受损(t 分别为-5.34、-4.02,P 均<0.05);妊娠期高血压疾病(HDCP)组婴儿18月龄语言发育得分(90.3±9.5)低于对照组,但无显著性差异(96.8±8.7, t=1.34,P>0.05);GDM 合并 HDCP组发育指标最低,18月龄适应性行为、语言发育指数均显著低于单纯组及对照组( t分别为4.28、5.17,P 均<0.01)。孕期体重增长过度组适应性行为发育指数比适宜组低5.7分( t=3.95,P<0.05),其与认知发育呈倒 U 型相关(r=-0.328,P<0.01)。纯母乳喂养组在适应性行为、语言、精细运动领域均显著优于人工喂养组( t值分别为5.26、6.37、4.89,P 均<0.01),混合喂养组指标介于两者之间。多因素线性回归分析显示,GDM、HDCP、孕期体重增长过度可显著降低子代18月龄神经发育指数(β=-4.26、-5.18、-3.95,P<0.05),纯母乳喂养可显著提升子代18月龄神经发育指数(β=6.37,P<0.01);妊娠合并症与孕期体重增长过度存在协同负面交互作用,纯母乳喂养对妊娠合并症高危人群子代的神经发育提升作用更显著。结论 妊娠期糖尿病、妊娠期高血压疾病、孕期体重增长过度可降低子代神经行为发育水平,纯母乳喂养可提升子代神经行为发育水平,临床应重视围产期全程管理以改善儿童神经发育结局。

Abstract

Objective To investigate the effects of maternal pregnancy complications, gestational weight gain, and feeding methods on offspring neurobehavioral development. Methods A retrospective cohort study was conducted, enrolling 527 mother-infant pairs. The participants were divided into groups according to pregnancy complications, gestational weight gain, and feeding methods for follow-up assessment. The Gesell Developmental Scale was used to evaluate the neurobehavioral development of the infants at 6, 12, and 18 months of age. Multivariate linear regression analysis was applied to examine the independent effects of each factor. Results The fine motor development quotient (92.6±8.7) at 12 months of age in the gestational diabetes mellitus (GDM) group was significantly lower than that in the control group (100.9±9.4, t=-6.12, P<0.01), and both fine motor and adaptive behavior development were impaired at 18 months of age (t= -5.34 and -4.02, respectively, P <0.05). In the hypertensive disorders complicating pregnancy (HDCP) group, the language development score (90.3±9.5) at 18 months of age was lower than that in the control group, but the difference was not statistically significant (96.8±8.7, t=1.34, P >0.05). The combined GDM and HDCP group had the lowest developmental indices, with both adaptive behavior and language development indices at 18 months of age being significantly lower than those in the single-complication groups and the control group (t=4.28 and 5.17, respectively, P<0.01). The adaptive behavior development index in the excessive gestational weight gain group was 5.7 points lower than that in the appropriate weight gain group (t=3.95, P <0.05), and it showed an inverted U-shaped correlation with cognitive development (r=-0.328, P<0.01). The exclusive breastfeeding group was significantly superior to the formula feeding group in the domains of adaptive behavior, language, and fine motor skills (t=5.26, 6.37 and 4.89, respectively, P<0.01), while the mixed feeding group had indices between the two. Multivariate linear regression analysis showed that GDM, HDCP, and excessive gestational weight gain significantly reduced the offspring neurodevelopmental index at 18 months of age (β=-4.26, -5.18 and -3.95, respectively, P<0.05), while exclusive breastfeeding significantly increased the offspring neurodevelopmental index at 18 months of age (β=6.37, P<0.01). There was a synergistic negative interaction between pregnancy complications and excessive gestational weight gain, and exclusive breastfeeding had a more significant beneficial effect on neurodevelopment in offspring of high-risk populations with pregnancy complications. Conclusion GDM, HDCP, and excessive gestational weight gain can reduce the neurobehavioral development level of the offspring, while exclusive breastfeeding can improve it. Clinical attention should be paid to the whole perinatal management to improve children's neurodevelopmental outcomes.

关键词

妊娠合并症 / 孕期体重增长 / 喂养方式 / 子代 / 神经行为发育 / 队列研究

Key words

pregnancy complication / gestational weight gain / feeding method / offspring / neurobehavioral development / cohort study

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基金资助

张家港市卫生青年科技项目(ZKYL2420)

2020年度张家港市卫生青年科技项目(ZJGQNKJ202029)