论文部分内容阅读
目的:探讨妊娠相关焦虑与婴幼儿神经行为发育的关联及关键期。方法:研究对象源自马鞍山优生优育队列。于2013年5月至2014年9月在马鞍山市妇幼保健院产前保健门诊招募待产孕妇，纳入完成孕早、中、晚三期妊娠相关焦虑评估且有至少一次神经行为发育评估的2 242对母子为研究对象。采用《妊娠相关焦虑量表》随访评估孕妇孕早、中、晚三期妊娠相关焦虑症状；于婴幼儿6月龄和18月龄使用《年龄与发育进程问卷中文版》进行神经行为发育评估；采用二分类logistic回归法分析各期妊娠相关焦虑对婴幼儿神经行为发育的影响及关键期。结果:2 242名孕妇年龄为（26.62±3.65）岁，男童、低出生体重、6个月内纯母乳喂养所占比例分别为50%（1 120/2 242）、1.7%（38/2 242）和11.5%（252/2 191）。孕早、中、晚三期的妊娠相关焦虑的检出率分别为24.9%（558名）、28.6%（642名）和30.3%（674名）。调整人口学特征及其他两个时期的妊娠相关焦虑后，孕晚期妊娠相关焦虑可增加儿童6月龄时沟通能区［n RR（95%n CI）=3.52（1.89~6.58）］、个人-社会能区［n RR（95%n CI）= 2.46（1.10~5.49）］发育迟滞风险；孕晚期妊娠相关焦虑可增加儿童18月龄时精细运动能区［n RR（95%n CI）=2.07（1.11~3.85）］、解决问题能区［n RR（95%n CI）= 2.31（1.24~4.31）］发育迟滞风险。n 结论:母亲孕期妊娠相关焦虑会影响婴幼儿神经行为发育，孕晚期可能是关键期。“,”Objective:To investigate the influence and critical period of pregnancy-related anxiety during pregnancy on the neurobehavioral development of infants.Methods:The subjects of this study were derived from the Ma′anshan Birth Corhot. From May 2013 to September 2014, a total of 3 474 pregnant women who registered in Ma ′anshan Maternal and Child Health Care Center were enrolled in the study. A total of 2 242 mother-infant pairs who completed three times assessments of maternal anxiety and at least once assessment of infants′ neurobehavioral development were included in the final analysis. Maternal pregnancy-related anxiety was assessed by the Pregnancy-Related Anxiety Questionnaire during the first, second and third trimesters of pregnancy. When their children were at 6 and 18 months, their neurobehavioral development was evaluated using the Ages & Stages Questionnaire-China. The influence of maternal pregnancy-related anxiety on the neurobehavioral development of infants was analyzed by bi-nominal logistic regression.Results:The age of 2 242 pregnant women was (26.62±3.65) years, and the proportion of boys, low birth weight and exclusive breastfeeding for 6 months was 50% (1 120/2 242), 1.7% (38/2 242) and 11.5% (252/2 191), respectively. The detection rates of pregnancy-related anxiety during the first, second and third trimester were 24.9% (558), 28.6% (642) and 30.3% (674), respectively. After controlling confounding variables and other two trimester′s anxiety, only pregnancy-related anxiety during the third trimester (not first or second trimester) significantly increased the risk of developmental delay in the domain of communication (relative risk, n RR = 3.52, 95% confidence interval, n CI: 1.89-6.58) and personal-social (n RR=2.46, 95%n CI: 1.10-5.49) at the 6 months of age, as well as in the domain of fine motor (n RR=2.07, 95%n CI: 1.11-3.85), problem-solving domains (n RR=2.31, 95%n CI: 1.24-4.31).n Conclusion:Maternal pregnancy-related anxiety was associated with the risk of neurobehavioral development of infants, and the third trimester may be the critical period.