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母亲妊娠特有焦虑与学龄前儿童孤独症样行为关系的出生队列研究
作者:孙艳丽 邵婷 姚余有 陶慧慧 倪玲玲 严双琴 顾春丽 曹慧 黄锟 陶芳标

摘要:

目的  分析母亲孕期暴露妊娠特有焦虑与学龄前儿童发生孤独症样行为(SAT)的关联。方法  基线资料来源于中国安徽出生队列(C-ABCS)中的马鞍山市出生队列。该队列于2008年10月至2010年10月在马鞍山市4家市级医疗卫生机构接受孕期保健的孕妇中招募研究对象,共计5 084名孕妇及4 669名单胎活产儿进入队列;使用《妊娠特有焦虑量表》(PAQ)评定母亲孕早期、孕晚期妊娠特有焦虑情况。于2014年4月至2015年4月对队列进行随访,采用家长填写的《克氏孤独症行为量表》(CABRS)对队列儿童进行SAT的筛查,共随访有CABRS评定结果的学龄前儿童3 663名。采用二分类非条件回归模型分析母亲孕早期、孕晚期妊娠特有焦虑与学龄前儿童SAT的关联。结果  母亲孕早、晚期妊娠特有焦虑的检出率分别为25.5%(935/3 663)、13.9%(501/3 592),母亲孕早、晚期均出现妊娠特有焦虑的检出率为7.7%(278/3 592)。学龄前儿童的SAT阳性率为7.9%(290例)。控制儿童性别、居住地、孕期增补叶酸、早产、孕期接触二手烟、父(母)亲文化水平、父(母)亲工作性质、家庭月收入等混杂因素后,母亲孕早期暴露妊娠特有焦虑是学龄前儿童发生SAT的危险因素(OR=1.51,95%CI:1.11~2.04),孕晚期暴露妊娠特有焦虑与儿童发生SAT无关联(OR=1.36, 95%CI:0.82~2.22);与母亲仅孕早期暴露妊娠特有焦虑或孕晚期暴露妊娠特有焦虑的单独作用相比,母亲孕早期和孕晚期都存在妊娠特有焦虑症状对儿童发生SAT存在联合作用,导致儿童发生SAT的风险增加,其OR(95%CI)值为2.02(1.36~2.98)。结论  孕期暴露妊娠期特有焦虑是儿童发生SAT的危险因素。孕妇在妊娠期应该尽量使自己保持良好的心理状态,为胎儿生长创造良好环境。

关键词:妊娠;焦虑;儿童,学龄前;孤独性障碍;队列研究

Abstract:

Objective  To analyze the associations between pregnancy-related anxiety and the prevalence of subthreshold autism trait (SAT) in preschool children.Methods  Baseline data came from the Ma'anshan Birth Cohort Study, a part of the China-Anhui Birth Cohort Study (C-ABCS). All the participants were enrolled among pregnant women who received prenatal health care in 4 municipal medical centers during Oct. 2008 to Oct. 2010. A total of 5 084 pregnant women were recruited at the beginning and 4 669 singleton live births were included until childbirth. The situation about pregnancy-specific anxiety during trimester and third trimester of women were evaluated by Pregnancy-specific Anxiety Questionnaire (PAQ). Between April 2014 and April 2015, the cohort was followed up again, and the Clancy Autism Behavior Scale (CABRS) filled out by parents was used for telling the SAT children from the healthy children among 3 663 preschool children. Univariate and binary regression model was used to estimate associations between the pregnancy-related anxiety during trimester and third trimester and the subthreshold autism trait in children.Results  During the pregnancy, the detected rates of women with pregnancy-specific anxiety in trimester and the third trimester were 25.5%(935/3 663), 13.9%(501/3 592) respectively, and the detected rate of maternal pregnancy-specific anxiety in both periods was 7.7%(278/3 592). There were 290 positive children with SAT and the detection rate was 7.9%. After controlling possible confounding factors including children's genders, place of residence, supplement folic acid during pregnancy, preterm birth, exposure to second-hand smoke during pregnancy, the father (mother) cultural levels, the father (mother) nature of work and family income, the results of multinomial logistic regression analysis showed that maternal pregnancy-specific anxiety in trimester was the risk factor for SAT in preschool children (OR=1.51, 95%CI: 1.11-2.04), and there was no association between maternal pregnancy-specific anxiety in the third trimester and SAT in preschool children (OR=1.36, 95%CI: 0.82-2.22). Compared with the single function of maternal pregnancy-specific anxiety in trimester or the third trimester for SAT in preschool children, maternal pregnancy-specific anxiety in both periods presented a joint action that increasing the risk for SAT (OR=2.02, 95%CI: 1.36-2.98).Conclusion  Maternal pregnancy-related anxiety was a risk factor for subthreshold autism trait in preschooler children. Pregnant women should try to keep a good mental state to create a good environment for fetal growth.

Key words: Pregnancy;Anxiety;Child, preschool;Autism disorder;Cohort studies

发表日期:2016/2

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2016.02.004.T001:表1 影响儿童孤独症样行为的单因素分析

    10.3760/cma.j.issn.0253-9624.2016.02.004.T001:表1 影响儿童孤独症样行为的单因素分析

  • 10.3760/cma.j.issn.0253-9624.2016.02.004.T002:表2 母亲孕期妊娠特有焦虑与学龄前儿童孤独症样行为关系的单因素分析

    10.3760/cma.j.issn.0253-9624.2016.02.004.T002:表2 母亲孕期妊娠特有焦虑与学龄前儿童孤独症样行为关系的单因素分析

  • 10.3760/cma.j.issn.0253-9624.2016.02.004.T003:表3 母亲孕期妊娠特有焦虑与学龄前儿童孤独症样行为关系的二分类非条件logistic回归模型分析结果

    10.3760/cma.j.issn.0253-9624.2016.02.004.T003:表3 母亲孕期妊娠特有焦虑与学龄前儿童孤独症样行为关系的二分类非条件logistic回归模型分析结果

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