母亲孕期缺铁性贫血与子代孤独症发生风险的关联分析

Association between prenatal maternal iron deficiency anemia and autism spectrum disorders in the offsprings

目的探究孕期母亲缺铁性贫血与子代孤独症谱系障碍(ASD)结局的关联,为ASD的早期预防及干预提供思路。方法于2018-2020年采用病例对照研究,选取ASD儿童145名(病例组)与正常儿童251名(对照组)纳入研究。采用调查问卷收集儿童及母亲一般情况及母亲孕期缺铁性贫血暴露等情况,采用单因素及多因素Logistic回归分析母亲孕期缺铁性贫血暴露与子代ASD发病的风险。进一步采用中介分析探索产儿科不良结局如剖宫产、早产、低出生体重在母亲孕期缺铁性贫血与子代ASD风险关联中的中介作用。结果ASD组母亲孕期缺铁性贫血发生率高于对照组(21.31%vs.7.56%,P<0.001)。单因素Logistic回归分析显示母亲孕期缺铁性贫血是子代发生ASD的危险因素(OR=3.31,95%CI:1.73~6.32)。在校正了儿童性别、母亲学历、母亲被动吸烟及孕早期营养素补充后,多因素Logistic回归分析结果趋势未发生改变(OR=3.44,95%CI:1.53~7.71)。本研究未见剖宫产(间接效应OR=0.99,95%CI:0.94~1.05)、早产(间接效应OR=1.00,95%CI:0.95~1.08)、低出生体重(间接效应OR=0.99,95%CI:0.94~1.04)在母亲缺铁性贫血和子代ASD发生风险中存在中介作用。结论母亲孕期缺铁性贫血是子代发生ASD的独立危险因素。孕期缺铁性贫血的早期筛查、早期干预十分必要,可减少子代ASD的发生风险。

Objective To explore the association between prenatal iron deficiency anemia and later risk of offspring′autism spectrum disorders(ASD),so as to provide clues for the early prevention and intervention for ASD.Methods A total of 145 children diagnosed with ASD(ASD group)and 251 healthy children(control group)were enrolled in this cross-sectional study in 2018-2020.The questionnaires were used to collect general family information and prenatal iron deficiency information.Univariate and multivariate Logistic regression analysis were conducted to examine the association between prenatal iron deficiency and the risk of offspring′s ASD.Mediation analysis was further performed to investigate whether the relationship between prenatal iron deficiency and offspring′s ASD was mediated by cesarean delivery,preterm or low birth weight.Results Compared with the control group,ASD children′s mothers had a higher rate of prenatal iron deficiency(21.31%vs.7.56%,P<0.001).Children exposed to prenatal iron deficiency had an increased risk of ASD(OR=3.31,95%CI:1.73—6.32).After adjusting the variables such as child′s sex,maternal education level,maternal passive smoking rate,nutrient supplementation in early pregnancy,the aforementioned trends remained.The association of prenatal iron deficiency with offspring′s ASD was not mediated through cesarean delivery(indirect effect OR=0.99,95%CI:0.94—1.05),preterm(indirect effect OR=1.00,95%CI:0.95—1.08),or low birth weight(indirect effect OR=0.99,95%CI:0.94—1.04).Conclusions Prenatal iron deficiency is associated with an increased risk of the development of the offspring′s ASD.Given that iron deficiency is common among pregnant women,early screening for iron deficiency anemia and nutrition counseling in antenatal care is necessary in reducing the risk of offspring′s ASD.